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Majewski D, Ball S, Talikowska M, Belcher J, Brits R, Finn J. Do differences in emergency medical services (EMS) response time to an arrest account for the survival differences between EMS-witnessed and bystander-witnessed out of hospital cardiac arrest? Resusc Plus 2024; 19:100696. [PMID: 39035408 PMCID: PMC11259960 DOI: 10.1016/j.resplu.2024.100696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction Out-of-hospital cardiac arrests (OHCA) witnessed by Emergency Medical Services (EMS) are reported to have more favourable survival than bystander-witnessed arrests, even after adjusting for patient and arrest factors known to be associated with increased OHCA survival. This study aims to determine whether the survival advantage in EMS-witnessed arrests can be attributed to differences in the EMS response time to the arrest. Methods Using registry data we conducted a retrospective, population-based cohort study of bystander- and EMS-witnessed OHCAs of medical aetiology who received an EMS resuscitation attempt in Western Australia between 2018-2021. EMS response time to arrest was assumed to be zero for EMS-witnessed arrests. Multivariable logistic regression was used to compare 30-day OHCA survival by witness and bystander CPR (B-CPR) status, adjusting for EMS response time to arrest, and patient and arrest characteristics. Results Of 2,130 OHCA cases, 510 (23.9%) were EMS-witnessed and 1620 were bystander-witnessed: 1318/1620 (81.4%) with B-CPR, and 302/1620 (18.6%) with no B-CPR. The median EMS response time to bystander-witnessed arrests who received B-CPR was 9.9 [Q1,Q3: 7.4, 13.3] minutes. After adjusting for the EMS response time and patient and arrest factors, 30-day survival remained significantly lower in both the bystander-witnessed group with B-CPR (aOR 0.56; 95% CI 0.34 - 0.91) and bystander-witnessed group without B-CPR (aOR 0.23; 95% CI 0.11 - 0.46). Conclusion An increased EMS response time does not fully account for the higher OHCA survival in EMS-witnessed arrests compared to bystander-witnessed arrests.
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Affiliation(s)
- David Majewski
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
- St John WA, Belmont, Western Australia, Australia
| | - Milena Talikowska
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
| | - Jason Belcher
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
- St John WA, Belmont, Western Australia, Australia
| | | | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
- St John WA, Belmont, Western Australia, Australia
- Medical School (Emergency Medicine), The University of Western Australia, Nedlands, Western Australia, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Nummela AJ, Scheinin H, Perola M, Joensuu A, Laitio R, Arola O, Grönlund J, Roine RO, Bäcklund M, Vahlberg TJ, Laitio T. A metabolic profile of xenon and metabolite associations with 6-month mortality after out-of-hospital cardiac arrest: A post-hoc study of the randomised Xe-Hypotheca trial. PLoS One 2024; 19:e0304966. [PMID: 38833442 PMCID: PMC11149864 DOI: 10.1371/journal.pone.0304966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 05/18/2024] [Indexed: 06/06/2024] Open
Abstract
PURPOSE Out-of-hospital cardiac arrest (OHCA) carries a relatively poor prognosis and requires multimodal prognostication to guide clinical decisions. Identification of previously unrecognized metabolic routes associated with patient outcome may contribute to future biomarker discovery. In OHCA, inhaled xenon elicits neuro- and cardioprotection. However, the metabolic effects remain unknown. MATERIALS AND METHODS In this post-hoc study of the randomised, 2-group, single-blind, phase 2 Xe-Hypotheca trial, 110 OHCA survivors were randomised 1:1 to receive targeted temperature management (TTM) at 33°C with or without inhaled xenon during 24 h. Blood samples for nuclear magnetic resonance spectroscopy metabolic profiling were drawn upon admission, at 24 and 72 h. RESULTS At 24 h, increased lactate, adjusted hazard-ratio 2.25, 95% CI [1.53; 3.30], p<0.001, and decreased branched-chain amino acids (BCAA) leucine 0.64 [0.5; 0.82], p = 0.007, and valine 0.37 [0.22; 0.63], p = 0.003, associated with 6-month mortality. At 72 h, increased lactate 2.77 [1.76; 4.36], p<0.001, and alanine 2.43 [1.56; 3.78], p = 0.001, and decreased small HDL cholesterol ester content (S-HDL-CE) 0.36 [0.19; 0.68], p = 0.021, associated with mortality. No difference was observed between xenon and control groups. CONCLUSIONS In OHCA patients receiving TTM with or without xenon, high lactate and alanine and decreased BCAAs and S-HDL-CE associated with increased mortality. It remains to be established whether current observations on BCAAs, and possibly alanine and lactate, could reflect neural damage via their roles in the metabolism of the neurotransmitter glutamate. Xenon did not significantly alter the measured metabolic profile, a potentially beneficial attribute in the context of compromised ICU patients. TRIAL REGISTRATION Trial Registry number: ClinicalTrials.gov Identifier: NCT00879892.
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Affiliation(s)
- Aleksi J. Nummela
- Department of Internal Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Harry Scheinin
- Department of Perioperative Services, Intensive Care and Pain Management, Turku University Hospital, University of Turku, Turku, Finland
- Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Markus Perola
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Faculty of Medicine, Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Anni Joensuu
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Faculty of Medicine, Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Ruut Laitio
- Department of Perioperative Services, Intensive Care and Pain Management, Turku University Hospital, University of Turku, Turku, Finland
| | - Olli Arola
- Department of Perioperative Services, Intensive Care and Pain Management, Turku University Hospital, University of Turku, Turku, Finland
| | - Juha Grönlund
- Department of Perioperative Services, Intensive Care and Pain Management, Turku University Hospital, University of Turku, Turku, Finland
| | - Risto O. Roine
- Division of Clinical Neurosciences, University of Turku, Turku University Hospital, Turku, Finland
| | - Minna Bäcklund
- Department of Anesthesiology, Intensive Care and Pain Medicine, Division of Intensive Care Medicine, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Tero J. Vahlberg
- Department of Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - Timo Laitio
- Department of Perioperative Services, Intensive Care and Pain Management, Turku University Hospital, University of Turku, Turku, Finland
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3
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Kim JH, Lee J, Shin H, Lim TH, Jang BH, Cho Y, Kim W, Choi KS, Kim JG, Ahn C, Lee H, Namgung M, Na MK, Kwon SM. Association Between QRS Characteristics in Pulseless Electrical Activity and Survival Outcome in Cardiac Arrest Patients: A Systematic Review and Meta-Analysis. PREHOSP EMERG CARE 2024:1-8. [PMID: 38787646 DOI: 10.1080/10903127.2024.2360139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE Recent studies have shown inconsistent results regarding the association between QRS characteristics and survival outcomes in patients with cardiac arrest and pulseless electrical activity (PEA) rhythms. This meta-analysis aimed to identify the usefulness of QRS width and frequency as prognostic tools for outcomes in patients with cardiac arrest and PEA rhythm. METHODS Extensive searches were conducted using Medline, Embase, and the Cochrane Library to find articles published from database inception to 4 June 2023. Studies that assessed the association between the QRS characteristics of cardiac arrest patients with PEA rhythm and survival outcomes were included. The Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies. RESULTS A total of 9727 patients from seven observational studies were included in this systematic review and meta-analysis. The wide QRS group (QRS ≥ 120 ms) was associated with significantly higher odds of mortality than the narrow QRS group (QRS < 120 ms) (odds ratio (OR) = 1.86, 95% confidence interval (CI) = 1.11-3.11, I2 = 58%). The pooled OR for mortality was significantly higher in patients with a QRS frequency of < 60/min than in those with a QRS frequency of ≥ 60/min (OR = 1.90, 95% CI = 1.19-3.02, I2 = 65%). CONCLUSIONS Wide QRS width or low QRS frequency is associated with increased odds of mortality in patients with PEA cardiac arrest. These findings may be beneficial to guide the disposition of cardiac arrest patients with PEA during resuscitation.
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Affiliation(s)
- Jae Hwan Kim
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Juncheol Lee
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyungoo Shin
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Bo-Hyoung Jang
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Youngsuk Cho
- Department of Emergency Medicine, Hallym University, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Wonhee Kim
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jae Guk Kim
- Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Heekyung Lee
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Myeong Namgung
- Department of Emergency Medicine, College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, Republic of Korea
| | - Min Kyun Na
- Department of Neurosurgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sae Min Kwon
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
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Frykler Abazi L, Liliequist A, Böhm F, Hedberg M, Simonsson M, Bäckman A, Ax M, Braunschweig F, Mellbin L, Linder R, Svensson L, Jurga J, Nordberg P, Ringh M, Forsberg S, Hollenberg J. Implementation of an extracorporeal resuscitation (ECPR) program for out-of-hospital cardiac arrest in Stockholm, Sweden: Feasibility, safety, and outcome. Resusc Plus 2024; 18:100596. [PMID: 38486930 PMCID: PMC10937228 DOI: 10.1016/j.resplu.2024.100596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
Background The aim of this study was to evaluate the implementation of a novel extra corporeal cardiopulmonary (ECPR) program in the greater Stockholm area with focus on feasibility, safety aspects and clinical outcomes. Methods Prospective observational study of ECPR program including patients with OHCA from January 2020 to December 2022, fulfilling ECPR criteria: age 18-65 years, initial shockable rhythm or pulseless electrical activity, witnessed arrest, bystander cardiopulmonary resuscitation and refractory arrest after three cycles of advance cardiac life support. The predefined time threshold from collapse to extracorporeal membrane oxygenation (ECMO) initiation was set at 60 min. Results We included 95 patients. Of these, 22/95 (23%) had return of spontaneous circulation before ECMO initiation, 39/95 (41%) were excluded for ECMO and 34/95 (36%) had ECMO initiated out of which 23 patients were admitted alive to the ICU. ECMO-initiation within 60 min was met in 9%. In 6 patients vascular access was complicated, 2 patients had severe bleeding at access site requiring intervention. Survival to discharge among all cases was 25% (24/95). Among patients admitted to ICU on ECMO 39% (9/23) survived to discharge, of these 78% had cerebral performance category scale score 1-2 within 12 months. 8 out of 9 survivors had time from OHCA to ECMO-initiation >60 min. Conclusion The implementation of an ECPR protocol was feasible without any major, unexpected safety aspects but did not meet the intended target time intervals. Despite this, survival rates were similar to previous studies although most survivors had >60 min to ECMO-initiation.
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Affiliation(s)
- Lis Frykler Abazi
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Sweden
| | - Andreas Liliequist
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Felix Böhm
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Hedberg
- Capio Rapid Response Cars and Perioperative Medicine & Intensive Care, Karolinska University Hospital and Department of Physiology and Pharmacology, Karolinska Institutet, Sweden
| | - Moa Simonsson
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anders Bäckman
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Sweden
| | - Malin Ax
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
| | - Linda Mellbin
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Rickard Linder
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Leif Svensson
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Sweden
| | - Juliane Jurga
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Per Nordberg
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Sweden
| | - Mattias Ringh
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Sweden
| | - Sune Forsberg
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Sweden
| | - Jacob Hollenberg
- Department of Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Sweden
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Sehara Y, Hashimotodani Y, Watano R, Ohba K, Uchibori R, Shimazaki K, Kawai K, Mizukami H. Adeno-associated Virus-mediated Ezh2 Knockdown Reduced the Increment of Newborn Neurons Induced by Forebrain Ischemia in Gerbil Dentate Gyrus. Mol Neurobiol 2024:10.1007/s12035-024-04200-w. [PMID: 38676810 DOI: 10.1007/s12035-024-04200-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/23/2024] [Indexed: 04/29/2024]
Abstract
It is established that neurogenesis of dentate gyrus is increased after ischemic insult, although the regulatory mechanisms have not yet been elucidated. In this study, we focused on Ezh2 which suppresses gene expression through catalyzing trimethylation of lysine 27 of histone 3. Male gerbils were injected with adeno-associated virus (AAV) carrying shRNA targeting to Ezh2 into right dentate gyrus 2 weeks prior to forebrain ischemia. One week after ischemia, animals were injected with thymidine analogue to label proliferating cells. Three weeks after ischemia, animals were killed for histological analysis. AAV-mediated knockdown of Ezh2 significantly decreased the ischemia-induced increment of proliferating cells, and the proliferated cells after ischemia showed significantly longer migration from subgranular zone (SGZ), compared to the control group. Furthermore, the number of neural stem cells in SGZ significantly decreased after ischemia with Ezh2 knockdown group. Of note, Ezh2 knockdown did not affect the number of proliferating cells or the migration from SGZ in the non-ischemic condition. Our data showed that, specifically after ischemia, Ezh2 knockdown shifted the balance between self-renewal and differentiation toward differentiation in adult dentate gyrus.
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Affiliation(s)
- Yoshihide Sehara
- Division of Genetic Therapeutics, Center for Molecular Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | | | - Ryota Watano
- Division of Genetic Therapeutics, Center for Molecular Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kenji Ohba
- Division of Genetic Therapeutics, Center for Molecular Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Ryosuke Uchibori
- Division of Genetic Therapeutics, Center for Molecular Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kuniko Shimazaki
- Department of Neurosurgery, Jichi Medical University, Shimotsuke, Japan
| | - Kensuke Kawai
- Department of Neurosurgery, Jichi Medical University, Shimotsuke, Japan
| | - Hiroaki Mizukami
- Division of Genetic Therapeutics, Center for Molecular Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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Tarnovski L, Šantek P, Rožić I, Čučević Đ, Mahečić LM, Marić J, Lovaković J, Martinić D, Rašić F, Rašić Ž. Out-of-Hospital Cardiac Arrest in the Eye of the Beholder and Emergency Medical Service. Open Access Emerg Med 2024; 16:91-99. [PMID: 38699221 PMCID: PMC11063469 DOI: 10.2147/oaem.s449157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/17/2024] [Indexed: 05/05/2024] Open
Abstract
Purpose Out-of-hospital cardiac arrest (OHCA) remains a global healthcare problem, with low survival and bystander cardiopulmonary resuscitation (CPR) rates. This study aimed to identify event-related factors in OHCA and their impact on return of spontaneous circulation (ROSC) achievement and maintenance until hospital admission. Patients and Methods All data were collected from Utstein Resuscitation Registry Template for OHCA from The Institute of Emergency Medicine of Zagreb from January 2012 to August 2022. This cross-sectional research analyzed 2839 Utstein reports, including 2001 male, 836 female, and 8 subjects of unknown gender. The average age was 65.4 ± 16.2 years. Results The most frequent place of collapse was private residence, and 27% of collapses were unwitnessed. Dispatcher-provided CPR instructions were provided in 39.7% of cases until the arrival of the emergency service team, which showed a very strong effect on bystander-provided CPR, and were followed in 68.4% of cases, while non-instructed bystander CPR was provided in only 7.9% of cases. Bystander CPR is more likely to be provided in public places than in private residences, often with both compression and ventilation. Bystander CPR was also more likely to be provided to men. Cases with bystander CPR, and compressions with ventilation compared to compression only CPR, showed a significantly greater success in maintaining ROSC later in CPR, both with moderate effects. Conclusion Bystander CPR has been shown to have a significant role in achieving and maintaining ROSC until hospital admission. However, our results showed a location-dependent nature of bystanders' willingness to perform CPR as well as sex disparities in patients receiving CPR. With deficient education in basic life support in Croatia, dispatchers need to insist on and instruct bystander CPR performance.
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Affiliation(s)
| | - Porin Šantek
- Institute of Emergency Medicine of Zagreb, Zagreb, Croatia
| | - Ivana Rožić
- Institute of Emergency Medicine of Zagreb, Zagreb, Croatia
| | - Đivo Čučević
- Department of Anesthesiology and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Jana Marić
- Institute of Emergency Medicine of Zagreb, Zagreb, Croatia
| | - Josip Lovaković
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Fran Rašić
- Department of Obstetrics and Gynecology, University Hospital “Sveti Duh”, Zagreb, Croatia
| | - Žarko Rašić
- Institute of Emergency Medicine of Zagreb, Zagreb, Croatia
- Department of Surgery, University Hospital “Sveti Duh”, Zagreb, Croatia
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Zègre-Hemsey JK, Cheskes S, Johnson AM, Rosamond WD, Cunningham CJ, Arnold E, Schierbeck S, Claesson A. Challenges & barriers for real-time integration of drones in emergency cardiac care: Lessons from the United States, Sweden, & Canada. Resusc Plus 2024; 17:100554. [PMID: 38317722 PMCID: PMC10838948 DOI: 10.1016/j.resplu.2024.100554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
Importance Out-of-hospital cardiac arrest (OHCA) is a leading cause of morbidity and mortality in the US and Europe (∼600,000 incident events annually) and around the world (∼3.8 million). With every minute that passes without cardiopulmonary resuscitation or defibrillation, the probability of survival decreases by 10%. Preliminary studies suggest that uncrewed aircraft systems, also known as drones, can deliver automated external defibrillators (AEDs) to OHCA victims faster than ground transport and potentially save lives. Objective To date, the United States (US), Sweden, and Canada have made significant contributions to the knowledge base regarding AED-equipped drones. The purpose of this Special Communication is to explore the challenges and facilitators impacting the progress of AED-equipped drone integration into emergency medicine research and applications in the US, Sweden, and Canada. We also explore opportunities to propel this innovative and important research forward. Evidence review In this narrative review, we summarize the AED-drone research to date from the US, Sweden, and Canada, including the first drone-assisted delivery of an AED to an OHCA. Further, we compare the research environment, emergency medical systems, and aviation regulatory environment in each country as they apply to OHCA, AEDs, and drones. Finally, we provide recommendations for advancing research and implementation of AED-drone technology into emergency care. Findings The rates that drone technologies have been integrated into both research and real-life emergency care in each country varies considerably. Based on current research, there is significant potential in incorporating AED-equipped drones into the chain of survival for OHCA emergency response. Comparing the different environments and systems in each country revealed ways that each can serve as a facilitator or barrier to future AED-drone research. Conclusions and relevance The US, Sweden, and Canada each offers different challenges and opportunities in this field of research. Together, the international community can learn from one another to optimize integration of AED-equipped drones into emergency systems of care.
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Affiliation(s)
| | - Sheldon Cheskes
- Department of Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Centre for Prehospital Medicine, Toronto, Ontario, Canada
| | - Anna M. Johnson
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, United States
| | - Wayne D. Rosamond
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, United States
| | | | - Evan Arnold
- North Carolina State University, Institute for Transportation Research and Education, United States
| | - Sofia Schierbeck
- Centre for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Claesson
- Centre for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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8
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Nassal MM, Wang HE, Benoit JL, Kuhn A, Powell JR, Keseg D, Sauto J, Panchal AR. Statewide implementation of the cardiac arrest registry to enhance survival in Ohio. Resusc Plus 2024; 17:100528. [PMID: 38178963 PMCID: PMC10765104 DOI: 10.1016/j.resplu.2023.100528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024] Open
Abstract
Objective Public health surveillance is essential for improving community health. The Cardiac Arrest Registry to Enhance Survival (CARES) is a surveillance system for out-of-hospital cardiac arrest (OHCA). We describe results of the organized statewide implementation of Ohio CARES. Methods We performed a retrospective analysis of CARES enactment in Ohio. Key elements included: establishment of statewide leadership, appointment of a dedicated coordinator, conversion to a statewide subscription, statewide dissemination of information, fundraising from internal and external stakeholders, and conduct of resuscitation academies. We identified all adult (≥18 years) OHCA reported in the registry during 2013-2020. We evaluated OHCA characteristics before (2013-2015) and after (2016-2019) statewide implementation using chi-square test. We evaluated trends in OHCA outcomes using the Cochran-Armitage test of trend. Results Statewide CARES promotion increased participation from 2 (urban) to 136 (129 urban, 7 rural) EMS agencies. Covered population increased from 1.2 M (10% of state) to 4.8 M (41% of state). After statewide implementation, OHCA populations increased male (58.1% vs 60.8%, p < 0.01), white (50.1% vs 63.7%, p < 0.01), bystander witnessed (26.9% vs 32.9%, p < 0.01) OHCAs. Bystander CPR (34.7% vs 33.2%, p = 0.22), bystander AED (13.5% vs 12.3%, p = 0.55) and initial rhythm (shockable 18.0% vs 18.3%, p = 0.32) did not change. From 2013 to 2019 there were temporal increases in ROSC (29.7% to 31.9%, p-trend = 0.028), survival (7.4% to 12.3%, p-trend < 0.001) and survival with good neurologic outcome (5.6% to 8.6%, p-trend = 0.047). Conclusion The organized statewide implementation of CARES in Ohio was associated with marked increases in community uptake and concurrent observed improvements in patient outcomes. These results highlight key lessons for community-wide fostering of OHCA surveillance.
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Affiliation(s)
- Michelle M.J. Nassal
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, United States
| | - Henry E. Wang
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, United States
| | - Justin L. Benoit
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States
| | | | - Jonathan R. Powell
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, United States
| | - David Keseg
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, United States
| | - James Sauto
- Department of Emergency Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Ashish R. Panchal
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, United States
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Forestell B, Ramsden S, Sharif S, Centofanti J, Al Lawati K, Fernando SM, Welsford M, Nichol G, Nolan JP, Rochwerg B. Supraglottic Airway Versus Tracheal Intubation for Airway Management in Out-of-Hospital Cardiac Arrest: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials. Crit Care Med 2024; 52:e89-e99. [PMID: 37962112 DOI: 10.1097/ccm.0000000000006112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVES Given the uncertainty regarding the optimal approach for airway management for adult patients with out-of-hospital cardiac arrest (OHCA), we conducted a systematic review and meta-analysis to compare the use of supraglottic airways (SGAs) with tracheal intubation for initial airway management in OHCA. DATA SOURCES We searched MEDLINE, PubMed, Embase, Cochrane Library, as well as unpublished sources, from inception to February 7, 2023. STUDY SELECTION We included randomized controlled trials (RCTs) of adult OHCA patients randomized to SGA compared with tracheal intubation for initial prehospital airway management. DATA EXTRACTION Reviewers screened abstracts, full texts, and extracted data independently and in duplicate. We pooled data using a random-effects model. We used the modified Cochrane risk of bias 2 tool and assessed certainty of evidence using the Grading Recommendations Assessment, Development, and Evaluation approach. We preregistered the protocol on PROSPERO (CRD42022342935). DATA SYNTHESIS We included four RCTs ( n = 13,412 patients). Compared with tracheal intubation , SGA use probably increases return of spontaneous circulation (ROSC) (relative risk [RR] 1.09; 95% CI, 1.02-1.15; moderate certainty) and leads to a faster time to airway placement (mean difference 2.5 min less; 95% CI, 1.6-3.4 min less; high certainty). SGA use may have no effect on survival at longest follow-up (RR 1.06; 95% CI, 0.84-1.34; low certainty), has an uncertain effect on survival with good functional outcome (RR 1.11; 95% CI, 0.82-1.50; very low certainty), and may have no effect on risk of aspiration (RR 1.04; 95% CI, 0.94 to 1.16; low certainty). CONCLUSIONS In adult patients with OHCA, compared with tracheal intubation, the use of SGA for initial airway management probably leads to more ROSC, and faster time to airway placement, but may have no effect on longer-term survival outcomes or aspiration events.
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Affiliation(s)
- Ben Forestell
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sophie Ramsden
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sameer Sharif
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada
- Departments of Emergency Medicine and Medicine, Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, WA
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
- Department of Anesthesia and Intensive Care Medicine, Royal United Hospital, Bath, United Kingdom
| | - John Centofanti
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Kumait Al Lawati
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shannon M Fernando
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada
| | - Michelle Welsford
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Graham Nichol
- Departments of Emergency Medicine and Medicine, Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, WA
| | - Jerry P Nolan
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
- Department of Anesthesia and Intensive Care Medicine, Royal United Hospital, Bath, United Kingdom
| | - Bram Rochwerg
- Division of Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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10
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Van Wijck SFM, Prins JTH, Verhofstad MHJ, Wijffels MME, Van Lieshout EMM. Rib fractures and other injuries after cardiopulmonary resuscitation for non-traumatic cardiac arrest: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2024:10.1007/s00068-023-02421-7. [PMID: 38206442 DOI: 10.1007/s00068-023-02421-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/04/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE This study aims to ascertain the prevalence of rib fractures and other injuries resulting from CPR and to compare manual with mechanically assisted CPR. An additional aim was to summarize the literature on surgical treatment for rib fractures following CPR. DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, Medline Ovid, Cochrane Central, Web of Science, and Google Scholar. REVIEW METHODS The databases were searched to identify studies reporting on CPR-related injuries in patients who underwent chest compressions for a non-traumatic cardiopulmonary arrest. Subgroup analysis was conducted to compare the prevalence of CPR-related injuries in manual versus mechanically assisted chest compressions. Studies reporting on surgery for CPR-related rib fractures were also reviewed and summarized. RESULTS Seventy-four studies reporting CPR-related injuries were included encompassing a total of 16,629 patients. Any CPR-related injury was documented in 60% (95% confidence interval [95% CI] 49-71) patients. Rib fractures emerged as the most common injury, with a pooled prevalence of 55% (95% CI 48-62). Mechanically assisted CPR, when compared to manual CPR, was associated with a higher risk ratio for CPR-related injuries of 1.36 (95% CI 1.17-1.59). Eight studies provided information on surgical stabilization of CPR-related rib fractures. The primary indication for surgery was the inability to wean from mechanical ventilation in the presence of multiple rib fractures. CONCLUSION Rib fractures and other injuries frequently occur in patients who undergo CPR after a non-traumatic cardiopulmonary arrest, especially when mechanical CPR is administered. Surgical stabilization of CPR-related rib fractures remains relatively uncommon. LEVEL OF EVIDENCE Level III, systematic review and meta-analysis.
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Affiliation(s)
- Suzanne F M Van Wijck
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Jonne T H Prins
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Mathieu M E Wijffels
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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11
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Eriksson CO, Bahr N, Meckler G, Hansen M, Walker-Stevenson G, Idris A, Aufderheide TP, Daya MR, Fink EL, Jui J, Luetje M, Martin-Gill C, Mcgaughey S, Pelletier J, Thomas D, Guise JM. Adverse Safety Events in Emergency Medical Services Care of Children With Out-of-Hospital Cardiac Arrest. JAMA Netw Open 2024; 7:e2351535. [PMID: 38214931 PMCID: PMC10787316 DOI: 10.1001/jamanetworkopen.2023.51535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Importance Survival for children with out-of-hospital cardiac arrest (OHCA) remains poor despite improvements in adult OHCA survival. Objective To characterize the frequency of and factors associated with adverse safety events (ASEs) in pediatric OHCA. Design, Setting, and Participants This population-based retrospective cohort study examined patient care reports from 51 emergency medical services (EMS) agencies in California, Georgia, Oregon, Pennsylvania, Texas, and Wisconsin for children younger than 18 years with an OHCA in which resuscitation was attempted by EMS personnel between 2013 and 2019. Medical record review was conducted from January 2019 to April 2022 and data analysis from October 2022 to February 2023. Main Outcomes and Measure Severe ASEs during the patient encounter (eg, failure to give an indicated medication, 10-fold medication overdose). Results A total of 1019 encounters of EMS-treated pediatric OHCA were evaluated; 465 patients (46%) were younger than 12 months. At least 1 severe ASE occurred in 610 patients (60%), and 310 patients (30%) had 2 or more. Neonates had the highest frequency of ASEs. The most common severe ASEs involved epinephrine administration (332 [30%]), vascular access (212 [19%]), and ventilation (160 [14%]). In multivariable logistic regression, the only factor associated with severe ASEs was young age. Neonates with birth-related and non-birth-related OHCA had greater odds of a severe ASE compared with adolescents (birth-related: odds ratio [OR], 7.0; 95% CI, 3.1-16.1; non-birth-related: OR, 3.4; 95% CI, 1.2-9.6). Conclusions and Relevance In this large geographically diverse cohort of children with EMS-treated OHCA, 60% of all patients experienced at least 1 severe ASE. The odds of a severe ASE were higher for neonates than adolescents and even higher when the cardiac arrest was birth related. Given the national increase in out-of-hospital births and ongoing poor outcomes of OHCA in young children, these findings represent an urgent call to action to improve care delivery and training for this population.
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Affiliation(s)
- Carl O Eriksson
- Department of Pediatrics, Oregon Health and Science University, Portland
| | - Nathan Bahr
- Department of Emergency Medicine, Oregon Health and Science University, Portland
| | - Garth Meckler
- Department of Pediatric Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew Hansen
- Department of Emergency Medicine, Oregon Health and Science University, Portland
| | | | - Ahamed Idris
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee
| | - Mohamud R Daya
- Department of Emergency Medicine, Oregon Health and Science University, Portland
| | - Ericka L Fink
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health and Science University, Portland
| | - Maureen Luetje
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee
| | - Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven Mcgaughey
- Department of Emergency Medicine, Oregon Health and Science University, Portland
| | - Jon Pelletier
- Department of Pediatrics, Akron's Children's Hospital, Akron, Ohio
| | - Danny Thomas
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Jeanne-Marie Guise
- Department of Obstetrics, Gynecology, and Reproductive Biology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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12
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Li ZH, Heidet M, Bal J, Ly S, Yan T, Scheuermeyer F, Stambulic M, Deakin J, Chakrabarti S, MacPherson A, Christenson J, Grunau B. Regional variation in accessibility of automated external defibrillators in British Columbia. CAN J EMERG MED 2024; 26:23-30. [PMID: 37976027 DOI: 10.1007/s43678-023-00610-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Bystander-applied Automated External Defibrillators (AED) improve outcomes for out-of-hospital cardiac arrest. AED placement is often driven by private enterprise or non-for-profit agencies, which may result in inequitable access. We sought to compare AED availability between four regions in British Columbia (BC). METHODS We identified AEDs (confirmed to be operational) and emergency medical system (EMS)-treated out-of-hospital cardiac arrests (OHCA) from provincial registries. We compared AED availability between BC's four most populous regions. The primary outcome was the total regional weekly accessible AED-hours per 100,000 population. We also examined: AEDs per 100,000 population and per km2, the ratio of AEDs to OHCA, and the distance from each OHCA to the closest AED. RESULTS From provincial registries, we included 879 AEDs from BC's four most populous regions, where 9333 EMS-treated OHCA occurred over a 5-year period. The most common AED location types were stores, public community centres, and office buildings. Ten percent of AEDs were accessible for all hours. Weekly accessible AED-hours/100,000 population in the four regions were: 3845, 1734, 1594, and 1299. AEDs/100,000 population ranged from 22 to 48, and AEDs/km2 ranged from 0.0048 to 0.20. The number of OHCAs per AED per year ranged from 1.1 to 2.8. The median OHCA-to-closest AED distance ranged from 503 (IQR 244, 947) to 925 (IQR 455, 1501) metres. The regional mean accessibility of individual AEDs ranged between 59 and 79 h per week. CONCLUSION BC's four most populous regions demonstrate substantial variability in AED accessibility. Further benefit could be derived from AEDs if placed in locations accessible all hours. Our data may encourage community planning efforts to use data-based strategies to systematically place AEDs in optimal locations with strategies to maximize accessibility.
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Affiliation(s)
- Zhang Hao Li
- Division of Radiation Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Matthieu Heidet
- Assistance Publique-Hôpitaux de Paris (AP-HP), SAMU 94 and Emergency Department, Hôpitaux Universitaires Henri Mondor, Créteil, France
- Université Paris-Est Créteil (UPEC), CIR (EA-3956), Créteil, France
- BC Resuscitation Research Collaborative, Vancouver, BC, Canada
| | - Joban Bal
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sophia Ly
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Tyler Yan
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Frank Scheuermeyer
- BC Resuscitation Research Collaborative, Vancouver, BC, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- St. Paul's Hospital, Vancouver, BC, Canada
| | | | - Jon Deakin
- BC Resuscitation Research Collaborative, Vancouver, BC, Canada
- British Columbia Emergency Health Services, Vancouver, BC, Canada
| | - Santabhanu Chakrabarti
- St. Paul's Hospital, Vancouver, BC, Canada
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Andrew MacPherson
- BC Resuscitation Research Collaborative, Vancouver, BC, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Emergency Health Services, Vancouver, BC, Canada
| | - Jim Christenson
- BC Resuscitation Research Collaborative, Vancouver, BC, Canada
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- St. Paul's Hospital, Vancouver, BC, Canada
| | - Brian Grunau
- BC Resuscitation Research Collaborative, Vancouver, BC, Canada.
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
- St. Paul's Hospital, Vancouver, BC, Canada.
- British Columbia Emergency Health Services, Vancouver, BC, Canada.
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13
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Heidet M, Benjamin Leung KH, Bougouin W, Alam R, Frattini B, Liang D, Jost D, Canon V, Deakin J, Hubert H, Christenson J, Vivien B, Chan T, Cariou A, Dumas F, Jouven X, Marijon E, Bennington S, Travers S, Souihi S, Mermet E, Freyssenge J, Arrouy L, Lecarpentier E, Derkenne C, Grunau B. Improving EMS response times for out-of-hospital cardiac arrest in urban areas using drone-like vertical take-off and landing air ambulances: An international, simulation-based cohort study. Resuscitation 2023; 193:109995. [PMID: 37813148 DOI: 10.1016/j.resuscitation.2023.109995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/12/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Advances in vertical take-off and landing (VTOL) technologies may enable drone-like crewed air ambulances to rapidly respond to out-of-hospital cardiac arrest (OHCA) in urban areas. We estimated the impact of incorporating VTOL air ambulances on OHCA response intervals in two large urban centres in France and Canada. METHODS We included adult OHCAs occurring between Jan. 2017-Dec. 2018 within Greater Paris in France and Metro Vancouver in Canada. Both regions utilize tiered OHCA response with basic (BLS)- and advanced life support (ALS)-capable units. We simulated incorporating 1-2 ALS-capable VTOL air ambulances dedicated to OHCA response in each study region, and computed time intervals from call reception by emergency medical services (EMS) to arrival of the: (1) first ALS unit ("call-to-ALS arrival interval"); and (2) first EMS unit ("call-to-first EMS arrival interval"). RESULTS There were 6,217 OHCAs included during the study period (3,760 in Greater Paris and 2,457 in Metro Vancouver). Historical median call-to-ALS arrival intervals were 21 min [IQR 16-29] in Greater Paris and 12 min [IQR 9-17] in Metro Vancouver, while median call-to-first EMS arrival intervals were 11 min [IQR 8-14] and 7 min [IQR 5-8] respectively. Incorporating 1-2 VTOL air ambulances improved median call-to-ALS arrival intervals to 7-9 min and call-to-first EMS arrival intervals to 6-8 min in both study regions (all P < 0.001). CONCLUSION VTOL air ambulances dedicated to OHCA response may improve EMS response intervals, with substantial improvements in ALS response metrics.
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Affiliation(s)
- Matthieu Heidet
- Assistance Publique-Hôpitaux de Paris (AP-HP), SAMU 94, Henri Mondor University Hospital, Créteil, France; Université Paris-Est Créteil (UPEC), CIR/TincNet (EA-3956), Créteil, France.
| | - K H Benjamin Leung
- Department of Mechanical and Industrial Engineering University of Toronto, Toronto, Canada
| | - Wulfran Bougouin
- Université de Paris, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris Sudden Death Expertise Center, Paris, France; Medical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Rejuana Alam
- Department of Mechanical and Industrial Engineering University of Toronto, Toronto, Canada
| | | | - Danny Liang
- Department of Emergency Medicine, University of Calgary, Calgary, Canada
| | - Daniel Jost
- Paris Fire Brigade (BSPP), Paris, France; Paris Sudden Death Expertise Center, Paris, France
| | | | | | | | - Jim Christenson
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Vancouver, Canada; Department of Emergency Medicine, St Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Benoît Vivien
- AP-HP, SAMU 75, Necker University Hospital, Paris, France
| | - Timothy Chan
- Department of Mechanical and Industrial Engineering University of Toronto, Toronto, Canada
| | - Alain Cariou
- Paris Sudden Death Expertise Center, Paris, France; AP-HP, Medical Intensive Care Unit, Cochin University Hospital, Paris, France
| | - Florence Dumas
- Université de Paris, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris Sudden Death Expertise Center, Paris, France; AP-HP, Emergency Department, Cochin-Hotel-Dieu University Hospital, Paris, France
| | - Xavier Jouven
- Université de Paris, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris Sudden Death Expertise Center, Paris, France; AP-HP, Cardiology Department, European Georges Pompidou University Hospital, Paris, France
| | - Eloi Marijon
- Université de Paris, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris Sudden Death Expertise Center, Paris, France; AP-HP, Cardiology Department, European Georges Pompidou University Hospital, Paris, France
| | - Steven Bennington
- Assistance Publique-Hôpitaux de Paris (AP-HP), SAMU 94, Henri Mondor University Hospital, Créteil, France
| | | | - Sami Souihi
- Université Paris-Est Créteil (UPEC), CIR/TincNet (EA-3956), Créteil, France
| | - Eric Mermet
- Centre National pour la Recherche scientifique (CNRS), TSE-R, UMR 5314, Toulouse, France; Toulouse School of Economics (TSE), Toulouse, France
| | - Julie Freyssenge
- Université Claude Bernard Lyon 1, INSERME U1290, Research on Healthcare Performance (RESHAPE), Lyon, France; Urgences-ARA Network, ARS Auvergne Rhône-Alpes, Lyon, France
| | - Laurence Arrouy
- AP-HP, Emergency Department, Paris Ile-de-France Ouest University Hospitals, Ambroise Paré University Hospital, Boulogne-Billancourt, France
| | - Eric Lecarpentier
- Assistance Publique-Hôpitaux de Paris (AP-HP), SAMU 94, Henri Mondor University Hospital, Créteil, France
| | - Clément Derkenne
- Medical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Brian Grunau
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Vancouver, Canada; Department of Emergency Medicine, St Paul's Hospital and University of British Columbia, Vancouver, Canada
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14
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Lim SL, Chan SP, Shahidah N, Ng QX, Ho AFW, Arulanandam S, Leong BSH, Ong MEH. Temporal trends in out-of-hospital cardiac arrest with an initial non-shockable rhythm in Singapore. Resusc Plus 2023; 16:100473. [PMID: 37727148 PMCID: PMC10506095 DOI: 10.1016/j.resplu.2023.100473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
Aim Out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm is the predominant form of OHCA in adults. We evaluated its 10-year trends in epidemiology and management in Singapore. Methods Using the national OHCA registry we studied the trends of 20,844 Emergency Medical Services-attended adult OHCA from April 2010 to December 2019. Survival to hospital discharge was the primary outcome. Trends and outcomes were analyzed using linear and logistic regression, respectively. Results Incidence rates of adult OHCAs increased during the study period, driven by non-shockable OHCA. Compared to shockable OHCA, non-shockable OHCAs were significantly older, had more co-morbidities, unwitnessed and residential arrests, longer no-flow time, and received less bystander cardiopulmonary resuscitation (CPR) and in-hospital interventions (p < 0.001). Amongst non-shockable OHCA, age, co-morbidities, residential arrests, no-flow time, time to patient, bystander CPR and epinephrine administration increased during the study period, while presumed cardiac etiology decreased (p < 0.05). Unlike shockable OHCA, survival for non-shockable OHCA did not improve (p < 0.001 for trend difference). The likelihood of survival for non-shockable OHCA significantly increased with witnessed arrest (adjusted odds ratio (aOR) 2.02) and bystander CPR (aOR 3.25), but decreased with presumed cardiac etiology (aOR 0.65), epinephrine administration (aOR 0.66), time to patient (aOR 0.93) and age (aOR 0.98). Significant two-way interactions were observed for no-flow time and residential arrest with bystander CPR (aOR 0.96 and 0.40 respectively). Conclusion The incidence of non-shockable OHCA increased between 2010 and 2019. Despite increased interventions, survival did not improve for non-shockable OHCA, in contrast to the improved survival for shockable OHCA.
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Affiliation(s)
- Shir Lynn Lim
- Department of Cardiology, National University Heart Centre, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore
| | - Siew Pang Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Cardiovascular Research Institute, National University Heart Centre, Singapore
| | - Nur Shahidah
- Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Qin Xiang Ng
- Health Services Research Unit, Singapore General Hospital, Singapore
| | - Andrew Fu Wah Ho
- Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Shalini Arulanandam
- Military Medicine Institute, Singapore Armed Forces Medical Corps, Singapore
| | | | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
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15
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Kusumawati HI, Sutono, Alim S, Achmad BF, Putri AF. Factors associated with willingness to perform basic life support in the community setting in Yogyakarta, Indonesia. Australas Emerg Care 2023; 26:303-307. [PMID: 36964023 DOI: 10.1016/j.auec.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/25/2023] [Accepted: 03/08/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Cardiac arrest is one of the fatal medical emergencies which need to be treated immediately. Poor survival rates in the community settings are common because of limited and ineffective bystander basic life support (BLS). This study aimed to identify factors that are associated with the willingness to perform BLS in communities in Yogyakarta, Indonesia METHODS: A descriptive study was conducted with a cross-sectional design. Participants (n = 251) were enrolled from the general population consisting of teachers, security personnel, and police officers recruited through cluster random sampling. Data were gathered using both digital or printed questionnaires. Ordinal logistic regression with adjusted odds ratio (AOR) was used to analyze the association between BLS predictors and willingness to perform BLS. RESULTS Most participants were willing to perform BLS for all genders (55.55%). The inability to perform BLS and fear of causing harm were the main barriers to performing BLS accounting for 61.35% and 43.82%, respectively. Compared to other independent predictors, ages 40-59 were found to be the highest predictors of willingness to perform BLS (AOR:1.44) followed by experience of seeing real or simulation of the emergency case (AOR:1.38) CONCLUSIONS: More than half of the respondents were eager to perform BLS although some barriers were also found. This study provides some understanding of the predictor factors associated with BLS performance and shows respondents with some training or experience were more likely to perform BLS. The results inform policymakers to develop a strategic plan for increasing willingness to apply BLS in the community. WC:250.
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Affiliation(s)
- Happy Indah Kusumawati
- Department of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia.
| | - Sutono
- Department of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
| | - Syahirul Alim
- Department of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
| | - Bayu Fandhi Achmad
- Department of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
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Usman M, Qureshi HZ, Zahid K, Bukhari SN. Role of coronary arteries in patients with Acute Coronary Syndrome. Pak J Med Sci 2023; 39:1717-1719. [PMID: 37936760 PMCID: PMC10626102 DOI: 10.12669/pjms.39.6.7173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 06/20/2023] [Accepted: 07/16/2023] [Indexed: 11/09/2023] Open
Abstract
Objective To assess the role of coronary arteries in acute coronary syndrome patients who have survived sudden cardiac arrest. Method A cross-sectional study was conducted in Department of Cardiology at Chaudhary Pervaiz Elahi Institute of Cardiology, Multan from 1st May 2021 to 1st October 2021. A total of 203 patients who were diagnosed with sudden cardiac arrest were included as subjects of the study. Baseline data of all patients including age, sex, body mass index, history of smoking, diabetes and hypertension was noted. Coronary angiography was performed in all patients within five days after admission in hospital due to SCA. Results The average age of patients was 52.61±11.09 years. There were 140 (68.97%) male and 63 (31.03%) female patients. There were 131 (64.53%) patients with STEMI and 72 (35.47%) patients with Non-STEMI. LMCAD were diagnosed in 29 (14.29%) patients, RCA in 88 (43.35%) patients, LAD in 174 (85.71%) Patients and LCX in 41 (20.20%) patients. Conclusion LAD has the most involvement among the coronary arteries (85.71%) in patients with sudden cardiac arrest.
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Affiliation(s)
- Muhammad Usman
- Dr. Muhammad Usman, MBBS, FCPSI, MO, Department of Cardiology, Ch. Pervaiz Elahi Institute of Cardiology Multan, Multan - Pakistan
| | - Hareem Zahra Qureshi
- Dr. Hareem Zahra Qureshi, MBBS, FCPSI, MO, Department of Cardiology, Ch. Pervaiz Elahi Institute of Cardiology Multan, Multan - Pakistan
| | - Kiran Zahid
- Dr. Kiran Zahid, MBBS, FCPSI, WMO, Department of Cardiology, Ch. Pervaiz Elahi Institute of Cardiology Multan, Multan - Pakistan
| | - Syed Naseem Bukhari
- Dr. Syed Naseem Bukhari, MBBS, FCPS, Assistant Professor, Department of Cardiology, Ch. Pervaiz Elahi Institute of Cardiology Multan, Multan - Pakistan
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17
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Wagner MK, Berg SK, Hassager C, Borregaard B, Rasmussen TB, Ekholm O, Stenbæk DS. Cognitive impairment and psychopathology in sudden out-of-hospital cardiac arrest survivors: Results from the REVIVAL cohort study. Resuscitation 2023; 192:109984. [PMID: 37797716 DOI: 10.1016/j.resuscitation.2023.109984] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023]
Abstract
AIM To investigate cognitive impairment and psychopathology in out-of-hospital cardiac arrest (OHCA) survivors using a screening procedure during hospitalisation and examine the evolution of these parameters at three-month follow-up. METHODS This multicentre cohort study screened for cognitive impairment using the Montreal Cognitive Assessment (MoCA), for symptoms of anxiety, depression and traumatic distress using the Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale-revised (IES-R) during hospitalisation. At three-month follow-up, we evaluated cognitive impairment with a neuropsychological test battery and symptoms of psychopathology were re-assessed using HADS and IES-R. Logistic regression models were applied to examine associations between screening results and outcomes. RESULTS This study included 297 OHCA survivors. During hospitalisation, 65% presented with cognitive impairment, 25% reported symptoms of anxiety, 20% symptoms of depression and 21% symptoms of traumatic distress. At follow-up, 53% reported cognitive impairment, 17% symptoms of anxiety, 15% symptoms of depression and 19% symptoms of traumatic distress. Cognitive impairment during hospitalisation was associated with higher odds (OR (95% CI) 2.55 (1.36-4.75), p = .02) of an unfavorable cognitive outcome at follow-up, and symptoms of psychopathology during hospitalisation were associated with higher odds of psychopathology at follow-up across all three symptom groups; anxiety (6.70 (2.40-18.72), p < .001), depression (4.69 (1.69-13.02), p < .001) and traumatic distress (7.07 (2.67-18.73), p < .001). CONCLUSION OHCA survivors exhibited both cognitive impairment and symptoms of psychopathology during hospitalisation comparable to previous studies, which were associated with unfavorable mental health outcomes at three-month follow-up.
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Affiliation(s)
- Mette Kirstine Wagner
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen E, Denmark.
| | - Selina Kikkenborg Berg
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen E, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen N, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen E, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen N, Denmark
| | - Britt Borregaard
- Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Department of Cardiology, Odense University Hospital, J.B. Winsloews Vej 4, 5000 Odense, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Dea Siggaard Stenbæk
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 6, 2100 Copenhagen E, Denmark; Institute of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Denmark
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18
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Vazanic D, Kurtovic B, Balija S, Milosevic M, Brborovic O. Predictors, Prevalence, and Clinical Outcomes of Out-of-Hospital Cardiac Arrests in Croatia: A Nationwide Study. Healthcare (Basel) 2023; 11:2729. [PMID: 37893803 PMCID: PMC10606582 DOI: 10.3390/healthcare11202729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) remains a pivotal health challenge globally. In Croatia, there has been a knowledge gap regarding the prevalence, predictors, and outcomes of OHCA patients. This study aims to determine the prevalence, prediction, and outcomes of OHCA patients in Croatia. METHODS An extensive one-year analysis was performed on all OHCA treated by the Emergency Medical Service in Croatia, based on the Utstein recommendations. Data were extracted from Croatian Institute of Emergency Medicine databases, focusing on adult individuals who experienced sudden cardiac arrest in out-of-hospital settings in Croatia. RESULTS From 7773 OHCA cases, 9.5% achieved spontaneous circulation pre-hospital. Optimal outcomes corresponded to EMS intervention within ≤13 min post-arrest onset AUC = 0.577 (95% CI: 0.56-0.59; p < 0.001) and female gender OR = 1.81 (95% CI: 1.49-2.19; p < 0.001). Northern Croatia witnessed lower success rates relative to the capital city Zagreb OR = 0.68 (95% CI: 0.50-0.93; p = 0.015). CONCLUSIONS Early intervention by EMS, specifically within a 13-min period following the onset of a cardiac arrest, significantly enhances the probability of achieving successful OHCA outcomes. Gender differences and specific initial heart rhythms further influenced the likelihood of successful outcomes. Regional disparities, with reduced success rates in northern Croatia compared to the City of Zagreb, were evident.
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Affiliation(s)
- Damir Vazanic
- Croatian Institute of Emergency Medicine, 10000 Zagreb, Croatia;
- Department of Nursing, Catholic University of Croatia, 10000 Zagreb, Croatia
- University of Applied Health Sciences, 10000 Zagreb, Croatia;
| | - Biljana Kurtovic
- University of Applied Health Sciences, 10000 Zagreb, Croatia;
- Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
| | - Sasa Balija
- Croatian Institute of Emergency Medicine, 10000 Zagreb, Croatia;
| | - Milan Milosevic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.M.); (O.B.)
| | - Ognjen Brborovic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.M.); (O.B.)
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19
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Marijon E, Narayanan K, Smith K, Barra S, Basso C, Blom MT, Crotti L, D'Avila A, Deo R, Dumas F, Dzudie A, Farrugia A, Greeley K, Hindricks G, Hua W, Ingles J, Iwami T, Junttila J, Koster RW, Le Polain De Waroux JB, Olasveengen TM, Ong MEH, Papadakis M, Sasson C, Shin SD, Tse HF, Tseng Z, Van Der Werf C, Folke F, Albert CM, Winkel BG. The Lancet Commission to reduce the global burden of sudden cardiac death: a call for multidisciplinary action. Lancet 2023; 402:883-936. [PMID: 37647926 DOI: 10.1016/s0140-6736(23)00875-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 09/01/2023]
Abstract
Despite major advancements in cardiovascular medicine, sudden cardiac death (SCD) continues to be an enormous medical and societal challenge, claiming millions of lives every year. Efforts to prevent SCD are hampered by imperfect risk prediction and inadequate solutions to specifically address arrhythmogenesis. Although resuscitation strategies have witnessed substantial evolution, there is a need to strengthen the organisation of community interventions and emergency medical systems across varied locations and health-care structures. With all the technological and medical advances of the 21st century, the fact that survival from sudden cardiac arrest (SCA) remains lower than 10% in most parts of the world is unacceptable. Recognising this urgent need, the Lancet Commission on SCD was constituted, bringing together 30 international experts in varied disciplines. Consistent progress in tackling SCD will require a completely revamped approach to SCD prevention, with wide-sweeping policy changes that will empower the development of both governmental and community-based programmes to maximise survival from SCA, and to comprehensively attend to survivors and decedents' families after the event. International collaborative efforts that maximally leverage and connect the expertise of various research organisations will need to be prioritised to properly address identified gaps. The Commission places substantial emphasis on the need to develop a multidisciplinary strategy that encompasses all aspects of SCD prevention and treatment. The Commission provides a critical assessment of the current scientific efforts in the field, and puts forth key recommendations to challenge, activate, and intensify efforts by both the scientific and global community with new directions, research, and innovation to reduce the burden of SCD worldwide.
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Affiliation(s)
- Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France.
| | - Kumar Narayanan
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Medicover Hospitals, Hyderabad, India
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Silverchain Group, Melbourne, VIC, Australia
| | - Sérgio Barra
- Department of Cardiology, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | - Cristina Basso
- Cardiovascular Pathology Unit-Azienda Ospedaliera and Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lia Crotti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Cardiomyopathy Unit and Laboratory of Cardiovascular Genetics, Department of Cardiology, Milan, Italy
| | - Andre D'Avila
- Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Cardiology, Hospital SOS Cardio, Santa Catarina, Brazil
| | - Rajat Deo
- Department of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Florence Dumas
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Emergency Department, Cochin Hospital, Paris, France
| | - Anastase Dzudie
- Cardiology and Cardiac Arrhythmia Unit, Department of Internal Medicine, DoualaGeneral Hospital, Douala, Cameroon; Yaounde Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Audrey Farrugia
- Hôpitaux Universitaires de Strasbourg, France, Strasbourg, France
| | - Kaitlyn Greeley
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France
| | | | - Wei Hua
- Cardiac Arrhythmia Center, FuWai Hospital, Beijing, China
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research and UNSW Sydney, Sydney, NSW, Australia
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Juhani Junttila
- MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Rudolph W Koster
- Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Theresa M Olasveengen
- Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital and Institute of Clinical Medicine, Oslo, Norway
| | - Marcus E H Ong
- Singapore General Hospital, Duke-NUS Medical School, Singapore
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's University of London, London, UK
| | | | - Sang Do Shin
- Department of Emergency Medicine at the Seoul National University College of Medicine, Seoul, South Korea
| | - Hung-Fat Tse
- University of Hong Kong, School of Clinical Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zian Tseng
- Division of Cardiology, UCSF Health, University of California, San Francisco Medical Center, San Francisco, California
| | - Christian Van Der Werf
- University of Amsterdam, Heart Center, Amsterdam, Netherlands; Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bo Gregers Winkel
- Department of Cardiology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
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20
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Abuelazm MT, Ghanem A, Katamesh BE, Hassan AR, Abdalshafy H, Seri AR, Awad AK, Abdelnabi M, Abdelazeem B. Defibrillation strategies for refractory ventricular fibrillation out-of-hospital cardiac arrest: A systematic review and network meta-analysis. Ann Noninvasive Electrocardiol 2023; 28:e13075. [PMID: 37482919 PMCID: PMC10475889 DOI: 10.1111/anec.13075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/10/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Double sequential external defibrillation (DSED) and vector-change defibrillation (VCD) have been suggested to enhance clinical outcomes for patients with ventricular fibrillation (VF) refractory of standard defibrillation (SD). Therefore, this network meta-analysis aims to evaluate the comparative efficacy of DSED, VCD, and SD for refractory VF. METHODS A systematic review and network meta-analysis synthesizing randomized controlled trials (RCTs) and comparative observational studies retrieved from PubMed, EMBASE, WOS, SCOPUS, and Cochrane through November 15th, 2022. R software netmeta and netrank package (R version 4.2.0) and meta-insight software were used to pool dichotomous outcomes using odds ratio (OR) presented with the corresponding confidence interval (CI). Our protocol was prospectively published in PROSPERO with ID: CRD42022378533. RESULTS We included seven studies with a total of 1632 participants. DSED was similar to SD in survival to hospital discharge (OR: 1.14 with 95% CI [0.55, 2.83]), favorable neurological outcome (modified Rankin scale ≤2 or cerebral performance category ≤2) (OR: 1.35 with 95% CI [0.46, 3.99]), and return of spontaneous circulation (ROSC) (OR: 0.81 with 95% CI [0.43; 1.5]). In addition, VCD was similar to SD in survival to hospital discharge (OR: 1.12 with 95% CI [0.27, 4.57]), favorable neurological outcome (OR: 1.01 with 95% CI [0.18, 5.75]), and ROSC (OR: 0.88 with 95% CI [0.24; 3.15]). CONCLUSION Double sequential external defibrillation and VCD were not associated with enhanced outcomes in patients with refractory VF out-of-hospital cardiac arrest, compared to SD. However, the current evidence is still inconclusive, warranting further large-scale RCTs.
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Affiliation(s)
| | - Ahmed Ghanem
- Cardiology DepartmentThe Lundquist InstituteTorranceCaliforniaUSA
| | | | | | | | - Amith Reddy Seri
- Department of Internal MedicineMcLaren Health CareFlintMichiganUSA
- Department of Internal MedicineMichigan State UniversityEast LansingMichiganUSA
| | | | - Mohamed Abdelnabi
- Department of Clinical PharmacyUniversity of MichiganAnn ArborMichiganUSA
| | - Basel Abdelazeem
- Department of Internal MedicineMcLaren Health CareFlintMichiganUSA
- Department of Internal MedicineMichigan State UniversityEast LansingMichiganUSA
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21
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Ray L, Geier C, DeWitt KM. Pathophysiology and treatment of adults with arrhythmias in the emergency department, part 2: Ventricular and bradyarrhythmias. Am J Health Syst Pharm 2023; 80:1123-1136. [PMID: 37235971 DOI: 10.1093/ajhp/zxad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE This is the second article in a 2-part series reviewing the pathophysiology and treatment considerations for arrhythmias. Part 1 of the series discussed aspects related to treating atrial arrhythmias. Here in part 2, the pathophysiology of ventricular arrhythmias and bradyarrhythmias and current evidence on treatment approaches are reviewed. SUMMARY Ventricular arrhythmias can arise suddenly and are a common cause of sudden cardiac death. Several antiarrhythmics may be effective in management of ventricular arrhythmias, but there is robust evidence to support the use of only a few of these agents, and such evidence was largely derived from trials involving patients with out-of-hospital cardiac arrest. Bradyarrhythmias range from asymptomatic mild prolongation of nodal conduction to severe conduction delays and impending cardiac arrest. Vasopressors, chronotropes, and pacing strategies require careful attention and titration to minimize adverse effects and patient harm. CONCLUSION Ventricular arrhythmias and bradyarrhythmias can be consequential and require acute intervention. As experts in pharmacotherapy, acute care pharmacists can participate in providing high-level intervention by aiding in diagnostic workup and medication selection.
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Affiliation(s)
- Lance Ray
- Denver Health and Hospital Authority, Denver, CO, and Department of Emergency Medicine, University of Colorado, Aurora, CO, USA
| | - Curtis Geier
- San Francisco General Hospital, San Francisco, CA, USA
| | - Kyle M DeWitt
- University of Vermont Medical Center, Burlington, VT, USA
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22
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Ahn C, Oh YT, Park Y, Kim JH, Hwang S, Won M. The Influence of Cardiac Arrest Floor-Level Location within a Building on Survival Outcomes. J Pers Med 2023; 13:1265. [PMID: 37623515 PMCID: PMC10455151 DOI: 10.3390/jpm13081265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
This nationwide, population-based observational study investigated the association between the floor level of out-of-hospital cardiac arrest (OHCA) incidence and survival outcomes in South Korea, notable for its significant high-rise apartment living. Data were collected retrospectively from OHCA patients through the South Korean Out-of-Hospital Cardiac Arrest Surveillance database. The study incorporated cases that included the OHCA's building floor information. The primary outcome assessed was survival to discharge, analyzed using multivariate logistic regression, and the secondary outcome was favorable neurological outcome. Among 36,977 patients, a total of 29,729 patients were included, and 1680 patients were survivors. A weak yet significant correlation between floor level and hospital arrival time was observed. Interestingly, elevated survival rates were noted among patients from higher floors despite extended emergency medical service response times. Multivariate analysis identified age, witnessed OHCA, shockable rhythm, and prehospital return of spontaneous circulation (ROSC) as primary determinants of survival to discharge. The floor level's impact on survival was less substantial than anticipated, suggesting residential emergency response enhancements should prioritize witness interventions, shockable rhythm management, and prehospital ROSC rates. The study underscores the importance of bespoke emergency response strategies in high-rise buildings, particularly in urban areas, and the potential of digital technologies to optimize response times and survival outcomes.
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Affiliation(s)
- Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea; (C.A.); (J.H.K.); (S.H.); (M.W.)
| | - Young Taeck Oh
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea;
| | - Yeonkyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Jae Hwan Kim
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea; (C.A.); (J.H.K.); (S.H.); (M.W.)
| | - Sojune Hwang
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea; (C.A.); (J.H.K.); (S.H.); (M.W.)
| | - Moonho Won
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea; (C.A.); (J.H.K.); (S.H.); (M.W.)
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23
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Imamura S, Miyata M, Tagata K, Yokomine T, Ohmure K, Kawasoe M, Otsuji H, Chaen H, Oketani N, Ogawa M, Nakamura K, Yoshino S, Kakihana Y, Ohishi M. Prognostic predictors in patients with cardiopulmonary arrest: A novel equation for evaluating the 30-day mortality. J Cardiol 2023; 82:146-152. [PMID: 36682713 DOI: 10.1016/j.jjcc.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 11/22/2022] [Accepted: 01/02/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Early prediction of outcomes after cardiopulmonary arrest (CPA) is important for considering the best support. Our purpose was to evaluate predictors of the 30-day mortality in patients with CPA after return of spontaneous circulation (ROSC) and to assess an equation for calculating the 30-day mortality using clinical parameters. METHODS We retrospectively analyzed the data of 194 consecutive patients with CPA and ROSC in a derivation study (2015-2022). We compared clinical parameters between the survived (n = 78) and dead (n = 116) patients. We derived an equation for estimated probability of death based on clinical parameters, using multivariate logistic regression analysis. The reliability of the equation was validated in 80 additional patients with CPA. RESULTS The 30-day mortality was associated with sex, witnessed cardiac arrest, bystander cardiopulmonary resuscitation (CPR), CPA due to acute myocardial infarction, pupil diameter, Glasgow Coma Scale score (GCS), presence of light reflex, arterial or venous pH, lactate levels, initial ventricular fibrillation (VF), CPA time, and age. The derived logistic regression equation was as follows: Estimated probability of death = 1 / (1 + e-x), x = (0.25 × bystander CPR) + (0.44 × pupil diameter) - (0.14 × GCS) + (0.09 × lactate) - (1.87 × initial VF) + (0.07 × CPA time) + (0.05 × age) - 7.03. The cut-off value for estimated probability of death calculated by this equation was 54.5 %, yielding a sensitivity, specificity, and accuracy of 86.2 %, 80.8 %, and 84.5 %, respectively. In the validation model, these values were 81.8 %, 85.7 %, and 82.5 %, respectively. CONCLUSIONS The 30-day mortality may be calculated after ROSC in patients with CPA using simple clinical parameters. This equation may facilitate further best support for patients with CPA.
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Affiliation(s)
- Shunichi Imamura
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan.
| | - Masaaki Miyata
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Kento Tagata
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Tatsuo Yokomine
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Kenta Ohmure
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Mariko Kawasoe
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Hideaki Otsuji
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Hideto Chaen
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Naoya Oketani
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Masakazu Ogawa
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Kentaro Nakamura
- Department of Emergency Medicine, Ohshima Prefectural Hospital, Kagoshima, Japan
| | - Satoshi Yoshino
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yasuyuki Kakihana
- Department of Emergency Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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24
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Oh YT, Ahn C. Characteristics and Treatment Outcomes of Out-of-Hospital Cardiac Arrests Occurring in Public Places: A National Population-Based Observational Study. J Pers Med 2023; 13:1191. [PMID: 37623442 PMCID: PMC10455591 DOI: 10.3390/jpm13081191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Sudden cardiac arrest, particularly out-of-hospital cardiac arrest (OHCA), is a global public health concern. However, limited research exists on the epidemiology of OHCAs occurring in public places, trends and impact of bystander intervention, and influence of extraordinary circumstances. This study investigated the epidemiological factors, bystander characteristics, and outcomes of OHCAs that occurred in public places in South Korea from 2016 to 2021 and analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic. A retrospective analysis was conducted using an Out-of-Hospital Cardiac Arrest Surveillance database, including 33,206 cases of OHCA that occurred in public places. Cases with do-not-resuscitate orders or insufficient data were excluded. A steady increase in bystander-performed cardiopulmonary resuscitation over the years and a constant decrease in bystander automated external defibrillator (AED) use were observed. Survival-to-discharge rates for OHCAs remained relatively steady until a marginal decrease was observed during the pandemic (pandemic, 13.1%; pre-pandemic, 14.4%). Factors affecting survival included the presence of a shockable rhythm, witnessed arrest, cardiac arrest due to disease, use of bystander AED, and period relative to the COVID-19 pandemic. These findings emphasize the critical role of bystanders in outcomes of OHCAs and inform public health strategies on better management of OHCAs in public places.
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Affiliation(s)
- Young Taeck Oh
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea;
| | - Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea
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25
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Wang SL, Li N, Feng SY, Li Y. Serum neurofilament light chain as a predictive marker of neurologic outcome after cardiac arrest: a meta-analysis. BMC Cardiovasc Disord 2023; 23:193. [PMID: 37061702 PMCID: PMC10105388 DOI: 10.1186/s12872-023-03220-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/31/2023] [Indexed: 04/17/2023] Open
Abstract
OBJECTIVE Recently, an increasing number of studies have suggested using serum neurofilament light (NfL) chain to predict the neurologic outcome after cardiac arrest. However, the predictive ability of this approach remains inconclusive. Meta-analysis was performed on related studies to assess the ability of serum NfL to predict the neurologic outcome after cardiac arrest. MATERIALS AND METHODS PubMed, ScienceDirect and Embase were systematically searched from the date of their inception until June 2022. Data were extracted to calculate the area under the receiver operating characteristic curve (AUC), the sensitivity, the specificity and the publication bias to evaluate the predictive power of serum NfL using Stata 14.0. RESULTS Nine studies were included in the present meta-analysis. Seven studies involving 1296 participants reported serum NfL 24 h post arrest for predicting the neurological outcome, and the AUC was 0.92 (77% sensitivity and 96% specificity). Seven studies involving 1020 participants reported serum NfL 48 h post arrest for predicting the neurological outcome, and the AUC was 0.94 (78% sensitivity and 98% specificity). Four studies involving 804 participants reported serum NfL 72 h post arrest for predicting the neurological outcome, and the AUC was 0.96 (90% sensitivity and 98% specificity). No significant publication bias was observed among the included studies. CONCLUSION The present meta-analysis results support the potential use of serum NfL as an early biomarker of neurologic outcome, especially 72 h post arrest.
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Affiliation(s)
- Shu Li Wang
- Emergency Deparment, Cangzhou Central Hospital, No.16 Xinhua Road, Yunhe Qu, Cangzhou City, 061000, China
| | - Nan Li
- Emergency Deparment, Cangzhou Central Hospital, No.16 Xinhua Road, Yunhe Qu, Cangzhou City, 061000, China
| | - Shun Yi Feng
- Emergency Deparment, Cangzhou Central Hospital, No.16 Xinhua Road, Yunhe Qu, Cangzhou City, 061000, China
| | - Yong Li
- Emergency Deparment, Cangzhou Central Hospital, No.16 Xinhua Road, Yunhe Qu, Cangzhou City, 061000, China.
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Jouffroy R, Ecollan P, Chollet-Xemard C, Prunet B, Elie C, Treluyer JM, Vivien B. Evaluation of the effectiveness of potassium chloride in the management of out-of hospital cardiac arrest by refractory ventricular fibrillation: Study protocol of the POTACREH study. PLoS One 2023; 18:e0284429. [PMID: 37043520 PMCID: PMC10096226 DOI: 10.1371/journal.pone.0284429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/10/2022] [Indexed: 04/13/2023] Open
Abstract
PURPOSE Out-of-hospital cardiac arrest (OHCA) has a poor prognosis, with an overall survival rate of about 5% at discharge. Shockable rhythm cardiac arrests (ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT)) have a better prognosis. In case of shockable rhythm, treatment is based on defibrillation, and thereafter, in case of failure of 3 external electric shocks (EES), on direct intravenous administration of 300 mg amiodarone, or lidocaine when amiodarone is unavailable or inefficient. During surgical procedures under extracorporeal circulation, a high potassium cardioplegia solution is administered to interrupt cardiac activity and facilitate surgical procedure. By extension, direct intravenous administration of potassium chloride (KCl) has been shown to convert VF, resulting in return to a hemodynamically efficient organized heart rate within a few minutes. The aim of this study is to provide clinical evidence that direct intravenous injection of KCl, into a patient presenting with OHCA due to refractory VF although 3 EES, should interrupt this VF and then allow rapid restauration of an organized heart rhythm, and thus return of spontaneous circulation (ROSC). METHODS A multicenter, prospective, single group, phase 2 study will be conducted on 81 patients presenting with refractory VF. After failure of 3 EES, each patient will receive direct intravenous injection of 20 mmol KCl instead of amiodarone. The primary outcome will be survival rate at hospital admission. Major secondary outcomes will include ROSC and time to ROSC in the prehospital setting, number of VF recidivism after KCl injection, survival rate at hospital discharge with a good neurologic prognostic, and survival rate 3 months after hospital discharge with a good neurologic prognostic. RESULTS No patient is currently included in the study. DISCUSSION Conventional guideline strategy based on antiarrhythmic drug administration, i.e. amiodarone or lidocaine, for OHCA due to shockable rhythm, has not yet demonstrated an increase in survival at hospital admission or at hospital discharge. This may be related to the major cardiodepressant effect of those drugs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04316611. Registered on March 2020. AP-HP180577 / N° EUDRACT: 2019-002544-24. Funded by the French Health Ministry. https://clinicaltrials.gov/ct2/show/NCT04316611.
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Affiliation(s)
- Romain Jouffroy
- SAMU de Paris, Service d’Anesthésie-Réanimation, Hôpital Universitaire Necker—Enfants Malades, APHP Centre, Assistance Publique—Hôpitaux de Paris and Université de Paris, Paris, France
| | - Patrick Ecollan
- SMUR Pitié Salpêtrière, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Charlotte Chollet-Xemard
- SAMU du Val de Marne, Hôpitaux Universitaires Henri Mondor, Assistance Publique—Hôpitaux de Paris, Créteil, France
| | | | - Caroline Elie
- URC Cochin, Assistance Publique—Hôpitaux de Paris, Paris, France
| | | | - Benoit Vivien
- SAMU de Paris, Service d’Anesthésie-Réanimation, Hôpital Universitaire Necker—Enfants Malades, APHP Centre, Assistance Publique—Hôpitaux de Paris and Université de Paris, Paris, France
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27
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Ko BS, Kim YJ, Han KS, Jo YH, Shin J, Park I, Kang H, Lim TH, Hwang SO, Kim WY. Association between the number of prehospital defibrillation attempts and a sustained return of spontaneous circulation: a retrospective, multicentre, registry-based study. Emerg Med J 2023; 40:424-430. [PMID: 37024298 DOI: 10.1136/emermed-2021-212091] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/25/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Currently, there is no consensus on the number of defibrillation attempts that should be made before transfer to a hospital in patients with out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the association between the number of defibrillations and a sustained prehospital return of spontaneous circulation (ROSC). METHODS A retrospective analysis of a multicentre, prospectively collected, registry-based study in Republic of Korea was conducted for OHCA patients with prehospital defibrillation. The primary outcome was sustained prehospital ROSC, and the secondary outcome was a good neurological outcome at hospital discharge, defined as Cerebral Performance Category score 1 or 2. Cumulative incidence of sustained prehospital ROSC and good neurological outcome according to number of defibrillations were examined. Multivariable logistic regression analysis was used to examine whether the number of defibrillations was independently associated with the outcomes. RESULTS Excluding 172 patients with missing data, a total of 1983 OHCA patients who received prehospital defibrillation were included. The median time from arrest to first defibrillation was 10 (IQR 7-15) min. The numbers of patients with sustained prehospital ROSC and good neurological outcome were 738 (37%) and 549 (28%), respectively. Sustained ROSC rates decreased as the number of defibrillation attempts increased from the first to the sixth (16%, 9%, 5%, 3%, 2% and 1%, respectively). The cumulative sustained ROSC rate, and good neurological outcome rate from initial defibrillation to sixth defibrillation were 16%, 25%, 30%, 34%, 36%, 36% and 11%, 18%, 22%, 25%, 26%, 27%, respectively. With adjustment for clinical characteristics and time to defibrillation, a higher number of defibrillations was independently associated with a lower chance of a sustained ROSC (OR 0.81, 95% CI 0.76 to 0.86) and a lower chance of good neurological outcome (OR 0.86, 95% CI 0.80 to 0.92). CONCLUSIONS We observed no significant increase in ROSC after five defibrillations, and no absolute increase in ROSC after seven defibrillations. These data provide a starting point for determination of the optimal defibrillation strategy prior to consideration for prehospital extracorporeal cardiopulmonary resuscitation (ECPR) or conveyance to a hospital with an ECPR capability. TRIAL REGISTRATION NUMBER NCT03222999.
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Affiliation(s)
- Byuk Sung Ko
- Department of Emergency Medicine, Hanyang University College of Medicine, Seongdong-gu, The Republic of Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, Songpa-gu, The Republic of Korea
| | - Kap Su Han
- Emergency Medicine, Korea University College of Medicine and School of Medicine, Seoul, The Republic of Korea
| | - You Hwan Jo
- Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, The Republic of Korea
| | - JongHwan Shin
- Emergency Medicine, Seoul National University College of Medicine, Seoul, The Republic of Korea
| | - Incheol Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seodaemun-gu, The Republic of Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, Hanyang University College of Medicine, Seongdong-gu, The Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seongdong-gu, The Republic of Korea
| | - S O Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, The Republic of Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, Songpa-gu, The Republic of Korea
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28
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Del Rios M. AED not applied: Why? Resuscitation 2023; 186:109782. [PMID: 37003512 DOI: 10.1016/j.resuscitation.2023.109782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Marina Del Rios
- University of Iowa - Carver College of Medicine, Iowa City, Iowa, USA.
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29
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Nishiyama C, Kiguchi T, Okubo M, Alihodžić H, Al-Araji R, Baldi E, Beganton F, Booth S, Bray J, Christensen E, Cresta R, Finn J, Grasner JT, Jouven X, Kern KB, Maconochie I, Masterson S, McNally B, Nolan JP, Eng Hock Ong M, Perkins GD, Ho Park J, Ristau P, Savastano S, Shahidah N, Do Shin S, Soar J, Tjelmeland I, Quinn MO, Wnent J, Wyckoff MH, Iwami T. Three-year trends in out-of-hospital cardiac arrest across the world: second report from the International Liaison Committee on Resuscitation (ILCOR). Resuscitation 2023; 186:109757. [PMID: 36868553 DOI: 10.1016/j.resuscitation.2023.109757] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND The International Liaison Committee on Resuscitation (ILCOR) Research and Registries Working Group previously reported data on systems of care and outcomes of out-of-hospital cardiac arrest (OHCA) in 2015 from 16 national and regional registries. To describe the temporal trends with updated data on OHCA, we report the characteristics of OHCA from 2015 through 2017. METHODS We invited national and regional population-based OHCA registries for voluntary participation and included emergency medical services (EMS)-treated OHCA. We collected descriptive summary data of core elements of the latest Utstein style recommendation during 2016 and 2017 at each registry. For registries that participated in the previous 2015 report, we also extracted the 2015 data. RESULTS Eleven national registries in North America, Europe, Asia, and Oceania, and 4 regional registries in Europe were included in this report. Across registries, the estimated annual incidence of EMS-treated OHCA was 30.0-97.1 individuals per 100,000 population in 2015, 36.4-97.3 in 2016, and 40.8-100.2 in 2017. The provision of bystander cardiopulmonary resuscitation (CPR) varied from 37.2% to 79.0% in 2015, from 2.9% to 78.4% in 2016, and from 4.1% to 80.3% in 2017. Survival to hospital discharge or 30-day survival for EMS-treated OHCA ranged from 5.2% to 15.7% in 2015, from 6.2% to 15.8% in 2016, and from 4.6% to 16.4% in 2017. CONCLUSION We observed an upward temporal trend in provision of bystander CPR in most registries. Although some registries showed favourable temporal trends in survival, less than half of registries in our study demonstrated such a trend.
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Affiliation(s)
- Chika Nishiyama
- Department of Critical Care Nursing, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tekeyuki Kiguchi
- Department of Preventive Services, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan; Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan
| | - Masashi Okubo
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hajriz Alihodžić
- Emergency Medical Service, Public Institution Health Centre 'Dr. Mustafa Šehović' and Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Rabab Al-Araji
- Emory University Woodruff Health Sciences Center, Atlanta, GA, USA
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Frankie Beganton
- Paris Cardiovascular Research Center (PARCC), Paris, France; Paris Sudden Death Expertise Center, Paris, France
| | - Scott Booth
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Janet Bray
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia; School of Nursing, Curtin University, WA, Australia
| | - Erika Christensen
- Center for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Ruggero Cresta
- Fondazione Ticino Cuore, Lugano, Switzerland; Federazione Cantonale Ticinese Servizi Autoambulanze, Bellinzona, Switzerland
| | - Judith Finn
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia; School of Nursing, Curtin University, WA, Australia; Medical School, University of Western Australia, WA, Australia
| | - Jan-Thorsten Grasner
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Xavier Jouven
- Paris Sudden Death Expertise Center, Paris, France; Department of Cardiology, Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Karl B Kern
- Division of Cardiology, University of Arizona, Sarver Heart Center, Tucson, AZ, USA
| | - Ian Maconochie
- Department of Emergency Medicine, Division of Medicine, Imperial College London, London, UK
| | - Siobhán Masterson
- Clinical Directorate, HSE National Ambulance Service, Ireland; Discipline of General Practice, National University of Ireland Galway, Ireland
| | - Bryan McNally
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jerry P Nolan
- Warwick Medical School, University of Warwick, Coventry and Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Gavin D Perkins
- Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, UK
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Patrick Ristau
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo(3), Pavia, Italy
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jasmeet Soar
- Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, UK
| | - Ingvild Tjelmeland
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany; Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Division of Prehospital Services, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | - Martin O Quinn
- Out-of-Hospital Cardiac Arrest Register Steering Group, National Ambulance Service, Health Service Executive, Ireland
| | - Jan Wnent
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taku Iwami
- Department of Preventive Services, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan.
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Early Versus Delayed Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation-A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Crit Care Explor 2023; 5:e0874. [PMID: 36861045 PMCID: PMC9970266 DOI: 10.1097/cce.0000000000000874] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
The optimal timing of coronary angiography remains unclear following out-of-hospital cardiac arrest (OHCA) without ST elevation on electrocardiogram. The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of early angiography versus delayed angiography following OHCA without ST elevation. DATA SOURCES The databases MEDLINE, PubMed EMBASE, and CINHAL, as well as unpublished sources from inception to March 9, 2022. STUDY SELECTION A systematic search was performed for randomized controlled trials of adult patients after OHCA without ST elevation who were randomized to early as compared to delayed angiography. DATA EXTRACTION Reviewers screened and abstracted data independently and in duplicate. The certainty of evidence was assessed for each outcome using the Grading Recommendations Assessment, Development and Evaluation approach. The protocol was preregistered (CRD 42021292228). DATA SYNTHESIS Six trials were included (n = 1,590 patients). Early angiography probably has no effect on mortality (relative risk [RR] 1.04; 95% CI 0.94-1.15; moderate certainty) and may have no effect on survival with good neurologic outcome (RR 0.97; 95% CI 0.87-1.07; low certainty) or ICU length of stay (LOS) (mean difference 0.41 days fewer; 95% CI -1.3 to 0.5 d; low certainty). Early angiography has an uncertain effect on adverse events. CONCLUSIONS In OHCA patients without ST elevation, early angiography probably has no effect on mortality and may have no effect on survival with good neurologic outcome and ICU LOS. Early angiography has an uncertain effect on adverse events.
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31
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Toy J, Tolles J, Bosson N, Hauck A, Abramson T, Sanko S, Kazan C, Eckstein M, Gausche-Hill M, Schlesinger SA. Association between a Post-Resuscitation Care Bundle and the Odds of Field Rearrest after Successful Resuscitation from Out-of-Hospital Cardiac Arrest: A Pre/Post Study. PREHOSP EMERG CARE 2023; 28:98-106. [PMID: 36692410 DOI: 10.1080/10903127.2023.2172633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Rearrest after successful resuscitation from out-of-hospital cardiac arrest (OHCA) is common and is associated with worse patient outcomes. However, little is known about the effect of interventions designed to prevent rearrest. We assessed the association between a prehospital care protocol for immediate management after return of spontaneous circulation (ROSC) and rates of field rearrest and survival to discharge in patients with prehospital ROSC. METHODS This was a retrospective study of adult patients with OHCA and field ROSC within a large EMS system before (April 2017-August 2018) and after (April 2019-February 2020) implementation of a structured prehospital post-ROSC care protocol. The protocol was introduced in September 2018 and provided on-scene stabilization direction including guidance on ventilation and blood pressure support. Field data and hospital outcomes were used to compare the frequency of field rearrest, hospital survival, and survival with good neurologic outcome before and after protocol implementation. Logistic regression was used to assess the association between the post-implementation period and these outcomes, and odds ratios were reported. The association between individual interventions on these outcomes was also explored. RESULTS There were 2,706 patients with ROSC after OHCA in the pre-implementation period and 1,780 patients in the post-implementation period. The rate of prehospital rearrest was 43% pre-implementation vs 45% post-implementation (RD 2%, 95% CI -1, 4%). In the adjusted analysis, introduction of the protocol was not associated with decreased odds of rearrest (OR 0.87, 95% CI 0.73, 1.04), survival to hospital discharge (OR 1.01, 95% CI 0.81, 1.24), or survival with good neurologic outcome (OR 0.81, 95% CI 0.61, 1.06). Post-implementation, post-ROSC administration of saline and push-dose epinephrine increased from 11% to 25% (RD 14%, 95% CI 11, 17%) and from 3% to 12% (RD 9% 95% CI 7, 11%), respectively. In an exploratory analysis, push-dose epinephrine was associated with a decreased odds of rearrest (OR 0.68, 95% CI 0.50, 0.94). CONCLUSIONS Introduction of a post-ROSC care protocol for patients with prehospital ROSC after OHCA was not associated with reduced odds of field rearrest. When elements of the care bundle were considered individually, push-dose epinephrine was associated with decreased odds of rearrest.
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Affiliation(s)
- Jake Toy
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- The Lundquist Institute, Torrance, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Los Angeles County EMS Agency, Santa Fe Springs, CA, USA
| | - Juliana Tolles
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- The Lundquist Institute, Torrance, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Nichole Bosson
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- The Lundquist Institute, Torrance, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Los Angeles County EMS Agency, Santa Fe Springs, CA, USA
| | - Aaron Hauck
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Tiffany Abramson
- Department of Emergency Medicine, Los Angeles County-USC Medical Center, Los Angeles, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stephen Sanko
- Department of Emergency Medicine, Los Angeles County-USC Medical Center, Los Angeles, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Los Angeles Fire Department, Los Angeles, CA, USA
| | - Clayton Kazan
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Los Angeles County Fire Department, Los Angeles, CA, USA
| | - Marc Eckstein
- Department of Emergency Medicine, Los Angeles County-USC Medical Center, Los Angeles, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Marianne Gausche-Hill
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- The Lundquist Institute, Torrance, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Los Angeles County EMS Agency, Santa Fe Springs, CA, USA
| | - Shira A Schlesinger
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- The Lundquist Institute, Torrance, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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32
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Aktaa S, Tzeis S, Gale CP, Ackerman MJ, Arbelo E, Behr ER, Crotti L, d'Avila A, de Chillou C, Deneke T, Figueiredo M, Friede T, Leclercq C, Merino JL, Semsarian C, Verstrael A, Zeppenfeld K, Tfelt-Hansen J, Reichlin T. European Society of Cardiology quality indicators for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Europace 2023; 25:199-210. [PMID: 36753478 PMCID: PMC10103575 DOI: 10.1093/europace/euac114] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 02/09/2023] Open
Abstract
To develop a suite of quality indicators (QIs) for the management of patients with ventricular arrhythmias (VA) and the prevention of sudden cardiac death (SCD). The Working Group comprised experts in heart rhythm management including Task Force members of the 2022 European Society of Cardiology (ESC) Clinical Practice Guidelines for the management of patients with VA and the prevention of SCD, members of the European Heart Rhythm Association, international experts, and a patient representative. We followed the ESC methodology for QI development, which involves (i) the identification of the key domains of care for the management of patients with VA and the prevention of SCD by constructing a conceptual framework of care, (ii) the development of candidate QIs by conducting a systematic review of the literature, (iii) the selection of the final set of QIs using a modified-Delphi method, and (iv) the evaluation of the feasibility of the developed QIs. We identified eight domains of care for the management of patients with VA and the prevention of SCD: (i) structural framework, (ii) screening and diagnosis, (iii) risk stratification, (iv) patient education and lifestyle modification, (v) pharmacological treatment, (vi) device therapy, (vii) catheter ablation, and (viii) outcomes, which included 17 main and 4 secondary QIs across these domains. Following a standardized methodology, we developed 21 QIs for the management of patients with VA and the prevention of SCD. The implementation of these QIs will improve the care and outcomes of patients with VA and contribute to the prevention of SCD.
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Affiliation(s)
- Suleman Aktaa
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS29JT, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS29JT, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | | | - Chris P Gale
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS29JT, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS29JT, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - Michael J Ackerman
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN 55905, USA
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona 08007, Spain
- IDIBAPS, Institut d’Investigació August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid 28029, Spain
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George’s, University of London, London SW17 0RE, UK
- St. George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Lia Crotti
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan 20149, Italy
- Departments of Medicine and Surgery, University of Milano-Bicocca, Milan 20126, Italy
| | - Andre d'Avila
- Director – Cardiac Arrhythmia Service The Harvard Thorndike EP Institute Beth Israel Deaconess Medical Center Harvard Medical School, Boston, MA 02215, USA
| | - Christian de Chillou
- Department of Cardiology, University Hospital Nancy,Vandœuvre lès Nancy 54500, France
| | - Thomas Deneke
- Heart Center Rhön-Clinic Bad Neustadt, Clinic for Interventional Electrophysiology, Bad Neustadt 97616, Germany
| | - Márcio Figueiredo
- Cardiology, Electrophysiology Service, University of Campinas (UNICAMP) Hospital, Campinas 13083-888, Brazil
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen,Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen 10785, Germany
| | | | - Jose L Merino
- La Paz University Hospital, IdiPaz, Autonoma University, Madrid 28046, Spain
| | - Chris Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, University of Sydney, Sydney 2050, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney 2050, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney 2050, Australia
| | | | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden 2333, TheNetherlands
| | - Jacob Tfelt-Hansen
- Section of genetics, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen 2100, Denmark
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet 2100, Denmark
| | - Tobias Reichlin
- Department of Cardiology, Inselspial Bern, Bern University Hospital, University of Bern, Bern 3010, Switzerland
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Stupca K, Scaturo N, Shomo E, King T, Frank M. Esmolol, vector change, and dose-capped epinephrine for prehospital ventricular fibrillation or pulseless ventricular tachycardia. Am J Emerg Med 2023; 64:46-50. [PMID: 36436299 DOI: 10.1016/j.ajem.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Refractory ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) cardiac arrest describes a subset of patients who do not respond to standard Advanced Cardiac Life Support (ACLS) interventions and are associated with poor outcomes. Esmolol administration and vector change defibrillation have shown promise in improving outcomes in these patients, however evidence is limited. OBJECTIVES This study compares clinical outcomes between patients with prehospital refractory VF/pVT who received an Emergency Medical Service (EMS) bundle, comprised of esmolol administration, vector change defibrillation, and dose-capped epinephrine at 3 mg, to patients who received standard ACLS interventions. METHODS This multicenter, retrospective, cohort study evaluated medical records between October 18, 2017 and March 15, 2022. Patients were enrolled if they experienced a prehospital cardiac arrest with the rhythm VF or pVT, had received at least three standard defibrillations, at least 3 mg of epinephrine, and 300 mg of amiodarone. Patients who received the EMS bundle after its implementation were compared to patients who received standard ACLS interventions prior to its implementation. The primary outcome was sustained return of spontaneous circulation (ROSC), defined as ROSC lasting 20 min without recurrence of cardiac arrest. Secondary outcomes included the incidence of any ROSC, survival to hospital arrival, survival at hospital discharge, and neurologically intact survival at hospital discharge. RESULTS Eighty-three patients were included in the study. Thirty-six were included in the pre-EMS bundle group and 47 patients were included in the post-EMS bundle group. Patients in the pre-EMS bundle group achieved significantly higher rates of sustained ROSC (58.3% vs 17%, p < 0.001), any ROSC (66.7% vs 19.1%, p < 0.001), and survival to hospital arrival (55.6% vs 17%, p < 0.001). The rates of survival to hospital discharge (16.7% vs 6.4%, p = 0.17) and neurologically intact survival at hospital discharge (5.9% vs 4.3%, p = 1.00) were not significantly different between groups. CONCLUSIONS Patients who received the EMS bundle achieved sustained ROSC significantly less often and were less likely to have pulses at hospital arrival. The incidence of neurologically intact survival was low and similar between groups.
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Affiliation(s)
- Kyle Stupca
- Department of Pharmaceutical Care Services, Sarasota Memorial Hospital, 1700 S Tamiami Trl, Sarasota, FL 34239, USA.
| | - Nicholas Scaturo
- Department of Pharmaceutical Care Services, Sarasota Memorial Hospital, 1700 S Tamiami Trl, Sarasota, FL 34239, USA
| | - Eileen Shomo
- Department of Pharmaceutical Care Services, Sarasota Memorial Hospital, 1700 S Tamiami Trl, Sarasota, FL 34239, USA
| | - Tonya King
- Research Institute, Sarasota Memorial Hospital, 1700 S Tamiami Trl, Sarasota, FL 34239, USA
| | - Marshall Frank
- Emergency Medicine Program, Florida State University, Sarasota Memorial Hospital, 1700 S Tamiami Trl, Sarasota, FL 34239, USA; Sarasota County Fire Department, 1660 Ringling Blvd, Sarasota, FL 34236, USA
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Boonmak S, Plailaharn N, Sripadungkul D, Somjit M, Gaysonsiri D, Boonmak P. A randomized controlled, non-inferiority trial of Moodle online learning for basic life support training on learning outcomes among dental students. J Dent Educ 2023; 87:110-117. [PMID: 36052470 DOI: 10.1002/jdd.13089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/11/2022] [Accepted: 07/31/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Dental students require basic life support (BLS) training to build their competency in cardiac arrest response. Online learning differs from the types of learning commonly practiced in Asia. We compared online learning and didactic lecture for BLS training in Thai dental students on knowledge, skill, and satisfaction. METHODS This was a randomized controlled, single-blinded, non-inferiority trial in fifth-year students from Khon Kaen University's Faculty of Dentistry from August 2015 to February 2016. Online learning was conducted using Modular Object-Oriented Dynamic Learning Environment (Moodle) 2.9 and required 90 min. Those in the didactic lecture group received a 90-min lecture covering similar content. Both groups received 2 h of skill training. After training, we evaluated their ability to pass a skills test, knowledge scores (immediately after training and 3 months later), and course satisfaction (5-point Likert scale). RESULTS We included 78 students and randomized them to online learning (39) or didactic lecture (39). The difference in proportion (95% confidence interval [CI]) of students passing the skills test on their first attempt was -1.5 (-20.8, 23.8), and all passed on their second attempt. The mean differences (95% CI) between the groups' immediate and 3 months knowledge scores were -2.5 (-6.2, 1.2), and -1.3 (-4.9, 2.3), respectively. The mean difference (95% CI) in satisfaction score was 0.02 (-0.28, 0.32). CONCLUSION Online learning and didactic lectures yielded comparable knowledge and skills, including satisfaction in Thai dental students. Online BLS training may alternatively aim for self-paced learning and increase flexibility. The recommendation is to increase online BLS learning in Thai culture.
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Affiliation(s)
- Suhattaya Boonmak
- Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Narin Plailaharn
- Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Darunee Sripadungkul
- Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Monsicha Somjit
- Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Dhanu Gaysonsiri
- Department of Pharmacology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Polpun Boonmak
- Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Shin SJ, Bae HS, Moon HJ, Kim GW, Cho YS, Lee DW, Jeong DK, Kim HJ, Lee HJ. Evaluation of optimal scene time interval for out-of-hospital cardiac arrest using a deep neural network. Am J Emerg Med 2023; 63:29-37. [PMID: 36544293 DOI: 10.1016/j.ajem.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 12/07/2022] Open
Abstract
AIM This study aims to develop a cardiac arrest prediction model using deep learning (CAPD) algorithm and to validate the developed algorithm by evaluating the change in out-of-hospital cardiac arrest patient prognosis according to the increase in scene time interval (STI). METHODS We conducted a retrospective cohort study using smart advanced life support trial data collected by the National Emergency Center from January 2016 to December 2019. The smart advanced life support data were randomly partitioned into derivation and validation datasets. The performance of the CAPD model using the patient's age, sex, event witness, bystander cardiopulmonary resuscitation (CPR), administration of epinephrine, initial shockable rhythm, prehospital defibrillation, provision of advanced life support, response time interval, and STI as prediction variables for prediction of a patient's prognosis was compared with conventional machine learning methods. After fixing other values of the input data, the changes in prognosis of the patient with respect to the increase in STI was observed. RESULTS A total of 16,992 patients were included in this study. The area under the receiver operating characteristic curve values for predicting prehospital return of spontaneous circulation (ROSC) and favorable neurological outcomes were 0.828 (95% confidence interval 0.826-0.830) and 0.907 (0.914-0.910), respectively. Our algorithm significantly outperformed other artificial intelligence algorithms and conventional methods. The neurological recovery rate was predicted to decrease to 1/3 of that at the beginning of cardiopulmonary resuscitation when the STI was 28 min, and the prehospital ROSC was predicted to decrease to 1/2 of its initial level when the STI was 30 min. CONCLUSION The CAPD exhibits potential and effectiveness in identifying patients with ROSC and favorable neurological outcomes for prehospital resuscitation.
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Affiliation(s)
- Seung Jae Shin
- Department of Industrial and System Engineering, Korea Advanced Institute of Science and Technology, Republic of Korea
| | - Hee Sun Bae
- Department of Industrial and System Engineering, Korea Advanced Institute of Science and Technology, Republic of Korea
| | - Hyung Jun Moon
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea.
| | - Gi Woon Kim
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea
| | - Young Soon Cho
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea
| | - Dong Wook Lee
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea
| | - Dong Kil Jeong
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea
| | - Hyun Joon Kim
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea
| | - Hyun Jung Lee
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea
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The aftermath of surviving a sudden cardiac arrest for young exercisers - a qualitative study in Norway. BMC Health Serv Res 2022; 22:1452. [PMID: 36451196 PMCID: PMC9709361 DOI: 10.1186/s12913-022-08674-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/11/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND When surviving a sudden cardiac arrest (SCA), physical, cognitive, and emotional effects of surviving may be present for months or years. The survivors' family and colleagues are also highly affected by the incident. There is little knowledge about experiences of surviving SCA in individuals who prior to the incident were young and reported to exercise regularly. Consequently, the aim of this study was to explore the aftermath of surviving a SCA in young, regular exercisers. METHODS The study had a qualitative design, conducting in-depth individual interviews with SCA survivors < 50 years of age reporting to exercise ≥ 5 h/week and/or who suffered SCA during or less than 60 min after exercise. The data were analysed using systematic text condensation in-line with recommendations from Malterud. RESULTS 18 of 31 eligible participants were included in the study. Through analysis we identified 'Establishing a new everyday life' as superordinate category, with subordinate categories a) being part of my surroundings, b) expecting normality but facing a new reality and c) lucky to be alive! CONCLUSION This study adds knowledge about young and regular exercisers' experiences after surviving a SCA. The obligations of everyday life in young survivors of SCA often imply a high work load and complex tasks, e.g. due to being in the beginning of their career or even still studying. Healthcare personnel, as well as the society, need to acknowledge that although lucky to be alive and apparently well-functioning, young survivors of SCA may have persistent challenges that cause frustration and reduced quality of life.
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Olson T, Anders M, Burgman C, Stephens A, Bastero P. Extracorporeal cardiopulmonary resuscitation in adults and children: A review of literature, published guidelines and pediatric single-center program building experience. Front Med (Lausanne) 2022; 9:935424. [PMID: 36479094 PMCID: PMC9720280 DOI: 10.3389/fmed.2022.935424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 11/04/2022] [Indexed: 09/19/2023] Open
Abstract
Extracorporeal cardiopulmonary resuscitation (ECPR) is an adjunct supportive therapy to conventional cardiopulmonary resuscitation (CCPR) employing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in the setting of refractory cardiac arrest. Its use has seen a significant increase in the past decade, providing hope for good functional recovery to patients with cardiac arrest refractory to conventional resuscitation maneuvers. This review paper aims to summarize key findings from the ECPR literature available to date as well as the recommendations for ECPR set forth by leading national and international resuscitation societies. Additionally, we describe the successful pediatric ECPR program at Texas Children's Hospital, highlighting the logistical, technical and educational features of the program.
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Affiliation(s)
- Taylor Olson
- Pediatric Critical Care Medicine, Children's National Hospital, Washington, DC, United States
| | - Marc Anders
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
- Pediatric Critical Care Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Cole Burgman
- ECMO, Texas Children's Hospital, Houston, TX, United States
| | - Adam Stephens
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
- Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Patricia Bastero
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
- Pediatric Critical Care Medicine, Texas Children's Hospital, Houston, TX, United States
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Meurer WJ, Kaplan A. Extracorporeal Membrane Oxygenation in the Emergency Department for Out-of-Hospital Cardiac Arrest. J Emerg Med 2022; 63:477-485. [DOI: 10.1016/j.jemermed.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/05/2022] [Indexed: 11/07/2022]
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Nedelea PL, Corlade-Andrei M, Kantor C, Popa OT, Manolescu E, Cimpoeșu D. Impact of Cardiopulmonary Resuscitation on Emergency Medical Staff—Romanian Perspective (IRESUS-EMS). J Clin Med 2022; 11:jcm11195707. [PMID: 36233575 PMCID: PMC9572908 DOI: 10.3390/jcm11195707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/20/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Unnecessary resuscitation is defined as putting in a disproportionate amount of effort compared to the patients’ prognosis and chance of survival. The primary objective of this study was to determine the number of resuscitations perceived as unnecessary by emergency medical personnel and to correlate it with the characteristics of resuscitation team members, patient particularities and organizational factors related to the professional environment. Methods: This was a prospective cross-sectional study carried out in the emergency department of a university hospital, exploring the perception of the uselessness of cardiopulmonary resuscitation (CPR) through the completion of a questionnaire. Results: In total, 70.37% of respondents are often involved in CPR attempts in which the efforts made are disproportionate compared to the patients’ expected prognosis, in terms of survival or quality of life. The presence of a non-shockable rhythm increased, by two times, the chances of medical staff finding it unnecessary to initiate CPR. Conclusions: The current study was the first in Romania to investigate the perception of unnecessary CPR, based on the recollection of the last resuscitation performed by the emergency medical staff. The objective criteria related to the patient were the most important predictors for assessing the adequacy of the decision to initiate CPR.
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Affiliation(s)
| | - Mihaela Corlade-Andrei
- Emergency “St. Spiridon” Hospital”, 700111 Iasi, Romania
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Correspondence: (M.C.-A.); (C.K.)
| | - Cristina Kantor
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Correspondence: (M.C.-A.); (C.K.)
| | - Ovidiu Tudor Popa
- Emergency “St. Spiridon” Hospital”, 700111 Iasi, Romania
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Emilian Manolescu
- Emergency “St. Spiridon” Hospital”, 700111 Iasi, Romania
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Diana Cimpoeșu
- Emergency “St. Spiridon” Hospital”, 700111 Iasi, Romania
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
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Gould J, Goldstein J, Travers AH, Swain JM, Carter A, Rollo D, Mekwan J, Atkinson P, Kovacs G. Potential Candidates for Emergency Department Initiated Extracorporeal Cardiopulmonary Resuscitation (ECPR) in a Canadian Institution. Cureus 2022; 14:e29318. [PMID: 36277569 PMCID: PMC9580229 DOI: 10.7759/cureus.29318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/18/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction Out-of-hospital cardiac arrest (OHCA) patients experience poor survival. The use of extracorporeal membrane oxygenation (ECMO), a form of heart-lung bypass, in the setting of cardiac arrest, termed extracorporeal cardiopulmonary resuscitation (ECPR), has promise in improving survival with good neurologic outcomes. The study objective was to determine the number of potential annual ECPR candidates among the OHCA population in a health region within the Atlantic Canadian province of Nova Scotia. Methods A retrospective chart review was conducted over a five-year period: January 1st, 2012 to December 31st, 2016. Consecutive non-traumatic OHCA and emergency department (ED) cardiac arrests occurring in a pre-determined catchment area (20-minute transport to ECMO center) defined by a geographic bounding box were identified. Criteria for ECPR were developed to identify candidates for activation of a “Code ECPR”: (1) age 16-70, (2) witnessed arrest, (3) no flow duration (time to CPR, including bystander) <10 minutes, (4) resuscitation >10 minutes without return of spontaneous circulation (ROSC), (5) emergency medical service (EMS) transport to hospital <20 minutes, (6) no patient factors precluding ongoing resuscitation (do not resuscitate status (DNR), palliative care involvement, or metastatic cancer), and (7) initial rhythm not asystole. Candidates were stratified by initial rhythm. Candidates were considered ultimately ED ECPR eligible if they failed conventional treatment, defined by death or resuscitation >30 minutes. Clinical data related to candidacy was extracted by an electronic query from prehospital and ED electronic records and manual chart review by three researchers. Results Our search yielded 561 cases of EMS-treated OHCA or in-ED arrests. Of those 204/561 (36%; 95% CI 33-40%) met the criteria for activation of a “Code ECPR”. Ultimately 79/204 (34%; 95% CI 28-41%) of those who met activation criteria were considered ED ECPR eligible; which is 14% (95% CI 11-17%) of the total number of arrests-of the total number of arrests, the initial rhythms were pulseless electrical activity (PEA) 33/79 (42%; 95% CI 32-53%) and shockable 46/79 (58%; 95% CI 47-69%). Conclusion Of all cardiac arrests in the area surrounding our ECMO center, approximately 41 per year met the criteria for a Code ECPR activation, with 16 per year ultimately being eligible for ED ECPR. This annual estimate varies based on the inclusion of initial rhythm. This provides insight into both prehospital and hospital implications of an ED ECPR program and will help guide the establishment of a program within our Nova Scotian health region. This study also provides a framework for similar investigation at other institutions contemplating ED ECPR program implementation.
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Sobti NK, Yeo I, Cheung JW, Feldman DN, Amin NP, Paul TK, Ascunce RR, Mecklai A, Marcus JL, Subramanyam P, Wong SC, Kim LK. Sex-Based Differences in 30-Day Readmissions After Cardiac Arrest: Analysis of the Nationwide Readmissions Database. J Am Heart Assoc 2022; 11:e025779. [PMID: 36073654 DOI: 10.1161/jaha.122.025779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There are limited data on the sex-based differences in the outcome of readmission after cardiac arrest. Methods and Results Using the Nationwide Readmissions Database, we analyzed patients hospitalized with cardiac arrest between 2010 and 2015. Based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, we identified comorbidities, therapeutic interventions, and outcomes. Multivariable logistic regression was performed to assess the independent association between sex and outcomes. Of 835 894 patients, 44.4% (n=371 455) were women, of whom 80.7% presented with pulseless electrical activity (PEA)/asystole. Women primarily presented with PEA/asystole (80.7% versus 72.4%) and had a greater comorbidity burden than men, as assessed using the Elixhauser Comorbidity Score. Thirty-day readmission rates were higher in women than men in both PEA/asystole (20.8% versus 19.6%) and ventricular tachycardia/ventricular fibrillation arrests (19.4% versus 17.1%). Among ventricular tachycardia/ventricular fibrillation arrest survivors, women were more likely than men to be readmitted because of noncardiac causes, predominantly infectious, respiratory, and gastrointestinal illnesses. Among PEA/asystole survivors, women were at higher risk for all-cause (adjusted odds ratio [aOR], 1.07; [95% CI, 1.03-1.11]), cardiac-cause (aOR, 1.15; [95% CI, 1.06-1.25]), and noncardiac-cause (aOR, 1.13; [95% CI, 1.04-1.22]) readmission. During the index hospitalization, women were less likely than men to receive therapeutic procedures, including coronary angiography and targeted therapeutic management. While the crude case fatality rate was higher in women, in both ventricular tachycardia/ventricular fibrillation (51.8% versus 47.4%) and PEA/asystole (69.3% versus 68.5%) arrests, sex was not independently associated with increased crude case fatality after adjusting for differences in baseline characteristics. Conclusions Women are at increased risk of readmission following cardiac arrest, independent of comorbidities and therapeutic interventions.
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Affiliation(s)
- Navjot Kaur Sobti
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College New York Presbyterian Hospital New York NY
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology Weill Cornell Medicine, New York Presbyterian Hospital New York NY
| | - Ilhwan Yeo
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College New York Presbyterian Hospital New York NY
- Division of Cardiology New York Presbyterian Queens Hospital New York NY
| | - Jim W Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College New York Presbyterian Hospital New York NY
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology Weill Cornell Medicine, New York Presbyterian Hospital New York NY
| | - Dmitriy N Feldman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College New York Presbyterian Hospital New York NY
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology Weill Cornell Medicine, New York Presbyterian Hospital New York NY
| | - Nivee P Amin
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College New York Presbyterian Hospital New York NY
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology Weill Cornell Medicine, New York Presbyterian Hospital New York NY
- Weill Cornell Women's Heart Program, Division of Cardiology, Department of Medicine Weill Cornell Medical College, New York Presbyterian Hospital New York NY
| | - Tracy K Paul
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College New York Presbyterian Hospital New York NY
- Weill Cornell Women's Heart Program, Division of Cardiology, Department of Medicine Weill Cornell Medical College, New York Presbyterian Hospital New York NY
| | - Rebecca R Ascunce
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College New York Presbyterian Hospital New York NY
- Weill Cornell Women's Heart Program, Division of Cardiology, Department of Medicine Weill Cornell Medical College, New York Presbyterian Hospital New York NY
| | - Alicia Mecklai
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College New York Presbyterian Hospital New York NY
- Weill Cornell Women's Heart Program, Division of Cardiology, Department of Medicine Weill Cornell Medical College, New York Presbyterian Hospital New York NY
| | - Julie L Marcus
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College New York Presbyterian Hospital New York NY
- Weill Cornell Women's Heart Program, Division of Cardiology, Department of Medicine Weill Cornell Medical College, New York Presbyterian Hospital New York NY
| | - Pritha Subramanyam
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College New York Presbyterian Hospital New York NY
| | - Shing-Chiu Wong
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College New York Presbyterian Hospital New York NY
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology Weill Cornell Medicine, New York Presbyterian Hospital New York NY
| | - Luke K Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College New York Presbyterian Hospital New York NY
- Weill Cornell Cardiovascular Outcomes Research Group (CORG), Department of Medicine, Division of Cardiology Weill Cornell Medicine, New York Presbyterian Hospital New York NY
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Lee MHM, Chia MYC, Fook-Chong S, Shahidah N, Tagami T, Ryu HH, Lin CH, Karim SA, Jirapong S, Rao HVR, Cai W, Velasco BP, Khan NU, Son DN, Naroo GY, El Sayed M, Ong MEH. Characteristics and Outcomes of Traumatic Cardiac Arrests in the Pan-Asian Resuscitation Outcomes Study. PREHOSP EMERG CARE 2022; 27:978-986. [PMID: 35994382 DOI: 10.1080/10903127.2022.2113941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Little is known about survival outcomes after traumatic cardiac arrest in Asia, or the association of Utstein factors with survival after traumatic cardiac arrests. This study aimed to describe the epidemiology and outcomes of traumatic cardiac arrests in Asia, and analyze Utstein factors associated with survival. METHODS Traumatic cardiac arrest patients from 13 countries in the Pan-Asian Resuscitation Outcomes Study registry from 2009 to 2018 were analyzed. Multilevel logistic regression was performed to identify factors associated with the primary outcomes of survival to hospital discharge and favorable neurological outcome (Cerebral Performance Category (CPC) 1-2), and the secondary outcome of return of spontaneous circulation (ROSC). RESULTS There were 207,455 out-of-hospital cardiac arrest cases, of which 13,631 (6.6%) were trauma patients aged 18 years and above with resuscitation attempted and who had survival outcomes reported. The median age was 57 years (interquartile range 39-73), 23.0% received bystander cardiopulmonary resuscitation (CPR), 1750 (12.8%) had ROSC, 461 (3.4%) survived to discharge, and 131 (1.0%) had CPC 1-2. Factors associated with higher rates of survival to discharge and favorable neurological outcome were arrests witnessed by emergency medical services or private ambulances (survival to discharge adjusted odds ratio (aOR) = 2.95, 95% confidence interval (CI) = 1.99-4.38; CPC 1-2 aOR = 2.57, 95% CI = 1.25-5.27), bystander CPR (survival to discharge aOR = 2.16; 95% CI 1.71-2.72; CPC 1-2 aOR = 4.98, 95% CI = 3.27-7.57), and initial shockable rhythm (survival to discharge aOR = 12.00; 95% CI = 6.80-21.17; CPC 1-2 aOR = 33.28, 95% CI = 11.39-97.23) or initial pulseless electrical activity (survival to discharge aOR = 3.98; 95% CI = 2.99-5.30; CPC 1-2 aOR = 5.67, 95% CI = 3.05-10.53) relative to asystole. CONCLUSIONS In traumatic cardiac arrest, early aggressive resuscitation may not be futile and bystander CPR may improve outcomes.
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Affiliation(s)
| | | | - Stephanie Fook-Chong
- Prehospital Emergency & Research Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Hyun Ho Ryu
- Department of Emergency Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Sarah Abdul Karim
- Department of Emergency Medicine, Hospital Sungai Buloh, Selangor, Malaysia
| | | | - H V Rajanarsing Rao
- Emergency Medicine Learning Centre, GVK Emergency Management and Research Institute, Secunderabad, Telangana, India
| | - Wenwei Cai
- Department of Emergency Medicine, Zhejiang Provincial People's Hospital, Zhejiang, China
| | | | - Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Do Ngoc Son
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam
| | - G Y Naroo
- ED-Trauma Centre, Rashid Hospital, Dubai, United Arab Emirates
| | - Mazen El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Health Services and Systems Research, Singapore, Singapore
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Robakowska M, Ślęzak D, Żuratyński P, Tyrańska-Fobke A, Robakowski P, Prędkiewicz P, Zorena K. Possibilities of Using UAVs in Pre-Hospital Security for Medical Emergencies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10754. [PMID: 36078469 PMCID: PMC9518096 DOI: 10.3390/ijerph191710754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/25/2022] [Accepted: 08/27/2022] [Indexed: 06/15/2023]
Abstract
The term unmanned aerial vehicle (UAV) was post-applied in the 1980s to describe remotely piloted multi-purpose, unmanned, autonomous aircraft. The terms unmanned aircraft systems with data terminal connectivity (UAS) and remotely piloted aircraft systems (RPV, RPAS-military systems) are also used. This review aims to analyze the feasibility of using UAVs to support emergency medical systems in the supply and urgent care ranges. The implementation of drones in the medical security system requires proper planning of service cooperation, division of the area into sectors, assessment of potential risks and opportunities, and legal framework for the application. A systematic literature search was conducted to assess the applicability based on published scientific papers on possible medical drone applications in the field of urgent mode. The widespread applications of UAVs in healthcare are concerned with logistics, scope, and transportability, with framework legal constraints to effectively exploit opportunities for improving population health, particularly for costly critical situations.
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Affiliation(s)
- Marlena Robakowska
- Department of Public Health & Social Medicine, Medical University of Gdańsk, 80-210 Gdansk, Poland
| | - Daniel Ślęzak
- Division of Medical Rescue, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 80-210 Gdansk, Poland
| | - Przemysław Żuratyński
- Division of Medical Rescue, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 80-210 Gdansk, Poland
- Department of Anesthesiology and Intensive Care, Oncology Center—Memorial Hospital in Bydgoszcz, 85-796 Bydgoszcz, Poland
| | - Anna Tyrańska-Fobke
- Department of Public Health & Social Medicine, Medical University of Gdańsk, 80-210 Gdansk, Poland
| | - Piotr Robakowski
- Division of Medical Rescue, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 80-210 Gdansk, Poland
| | - Paweł Prędkiewicz
- Department of Finance, Faculty of Economics and Finance, Wrocław University of Economics, 53-345 Wroclaw, Poland
| | - Katarzyna Zorena
- Department of Immunobiology and Environmental Microbiology, Medical University of Gdansk, 80-211 Gdansk, Poland
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Ritter ML, Bohr AD, McQueen MB. Association of Cardiac Arrest With Opioid Overdose in Transport. Subst Abuse 2022; 16:11782218221103582. [PMID: 35800885 PMCID: PMC9253981 DOI: 10.1177/11782218221103582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/06/2022] [Indexed: 11/30/2022]
Abstract
Introduction Drug overdose is the leading cause of injury-related death in the United States. It has been linked to respiratory depression and cardiac toxicity, both of which can lead to cardiac arrest. Despite this potential association, few studies have examined this relationship, particularly in transport to the hospital. The purpose of this research was to determine if there was a relationship between opioid overdose and cardiac arrest in transport. Methods A sample (n = 1 000 000) was utilized from the National EMS Information System (NEMSIS) from the year 2019. A logistic regression model was used to predict cardiac arrest from dispatch reason with gender, race, and age included as controls. Results Overdose-related dispatch reason was associated with an increased likelihood of cardiac arrest in transport (Odds Ratio = 1.65, 95% Confidence Interval: [1.22, 2.22]). Conclusions Opioid overdose is associated with an increased incidence of cardiac arrest in transport in the United States.
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Affiliation(s)
| | - Adam D Bohr
- University of Colorado Boulder,
Boulder, Coloroado, USA
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Malik A, Gewarges M, Pezzutti O, Allan KS, Samman A, Akioyamen LE, Ruiz M, Brijmohan A, Basuita M, Tanaka D, Scales D, Luk A, Lawler P, Kalra S, Dorian P. Association between sex and survival after non-traumatic out of hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation 2022; 179:172-182. [PMID: 35728744 DOI: 10.1016/j.resuscitation.2022.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Existing studies have shown conflicting results regarding the relationship of sex with survival after out of hospital cardiac arrest (OHCA). This systematic review evaluates the association of female sex with survival to discharge and survival to 30 days after non-traumatic OHCA. METHODS We searched Medline, Embase, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from inception through June 2021 for studies evaluating female sex as a predictor of survival in adult patients with non-traumatic cardiac arrest. Random-effects inverse variance meta-analyses were performed to calculate pooled odds ratios (ORs) with 95% confidence intervals (CI). The GRADE approach was used to assess evidence quality. RESULTS Thirty studies including 1,068,788 patients had female proportion of 41%. There was no association for female sex with survival to discharge (OR 1.03, 95% CI 0.95-1.12; I2=89%). Subgroup analysis of low risk of bias studies demonstrated increased survival to discharge for female sex (OR 1.20, 95% CI 1.18-1.23; I2=0%) and with high certainty, the absolute increase in survival was 2.2% (95% CI 0.1%-3.6%). Female sex was not associated with survival to 30 days post-OHCA (OR 1.02, 95% CI 0.92-1.14; I2=79%). CONCLUSIONS In adult patients experiencing OHCA, with high certainty in the evidence from studies with low risk of bias, female sex had a small absolute difference for the outcome survival to discharge and no difference in survival at 30 days. Future models that aim to stratify risk of survival post-OHCA should focus on sex-specific factors as opposed to sex as an isolated prognostic factor.
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Affiliation(s)
- Abdullah Malik
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mena Gewarges
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada
| | - Olivia Pezzutti
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Anas Samman
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Leo E Akioyamen
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Ruiz
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada
| | - Angela Brijmohan
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Manpreet Basuita
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dustin Tanaka
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Damon Scales
- Division of Critical Care, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Adriana Luk
- Division of Cardiology, Toronto General Hospital, Toronto, ON, Canada
| | - Patrick Lawler
- Division of Cardiology, Toronto General Hospital, Toronto, ON, Canada
| | - Sanjog Kalra
- Division of Cardiology, Toronto General Hospital, Toronto, ON, Canada
| | - Paul Dorian
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada.
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Out-of-hospital cardiac arrest with onset witnessed by emergency medical services: Implications for improvement in overall survival. Resuscitation 2022; 175:19-27. [PMID: 35421535 DOI: 10.1016/j.resuscitation.2022.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 01/18/2023]
Abstract
Out-of-hospital cardiac arrest (OHCA) remains a major public health problem. Even in high-income countries, survival rates have plateaued in the range of ten percent, stimulating an ongoing interest in developing novel approaches to resuscitation. Emergency Medical Services (EMS)-witnessed OHCAs constitute a subgroup of overall OHCA that occur after the arrival of EMS, leading to rapid initiation of resuscitation and significantly improved survival. In this narrative review we summarize and interpret recent developments in knowledge of EMS-witnessed OHCA regarding prevalence, demographics, location, circumstances, survival outcomes and clinical profile. We examine the possibility of informing novel resuscitation approaches and enhancing mechanistic knowledge by studying EMS-witnessed OHCA, with the goal of improving overall survival from OHCA.
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47
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Kim TH, Jung JH, Song KJ, Hong KJ, Jeong J, Lee SGW. Association between patient age and pediatric cardiac arrest recognition by emergency medical dispatchers. Am J Emerg Med 2022; 58:275-280. [DOI: 10.1016/j.ajem.2022.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/21/2022] [Accepted: 05/21/2022] [Indexed: 10/18/2022] Open
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Vetter VL, Griffis H, Dalldorf KF, Naim MY, Rossano J, Vellano K, McNally B, Glatz AC. Impact of State Laws: CPR Education in High Schools. J Am Coll Cardiol 2022; 79:2140-2143. [PMID: 35618352 DOI: 10.1016/j.jacc.2022.03.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/01/2022] [Accepted: 03/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Victoria L Vetter
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Heather Griffis
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Katherine F Dalldorf
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maryam Y Naim
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph Rossano
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Bryan McNally
- CARES Surveillance Group; Emory University, Woodruff Health Sciences Center, Atlanta, Georgia, USA; Rollins School of Public Health, Atlanta, Georgia, USA
| | - Andrew C Glatz
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Schoonover A, Eriksson CO, Nguyen T, Meckler G, Hansen M, Harrod T, Guise J. A chart review tool to systematically assess the safety of prehospital care for children with out‐of‐hospital cardiac arrest. J Am Coll Emerg Physicians Open 2022; 3:e12726. [PMID: 35505929 PMCID: PMC9051860 DOI: 10.1002/emp2.12726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 03/19/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Create an easy‐to‐use pediatric out‐of‐hospital cardiac arrest (OHCA)‐specific chart review tool to reliably detect severe adverse safety events (ASEs) in the prehospital care of children with OHCA. Methods We revised our previously validated pediatric prehospital adverse event detection system (PEDS) tool, used to evaluate ASEs in the prehospital care of children during emergent calls, to create an OHCA‐specific chart review tool. We developed decision support for reviewers, reviewer training, and a dedicated section for chart data abstraction. We randomly selected 28 charts for independent review by 2 expert reviewers who determined the presence or absence of a severe ASE for each care episode and identified the domain of care and preventability for each ASE. We calculated inter‐rater agreement in the assessment of the presence or absence of a severe ASE using Gwet's first‐order agreement coefficient (AC1). Results The PEDS‐OHCA chart review tool has 6 sections, with a minimum of 70 and maximum of 667 total possible fields. We found inter‐rater agreement of 0.83 (95% confidence interval, 0.63–0.99) between our 2 reviewers for the overall detection of a severe ASE and an average time to complete of 8 minutes (range, 2–25 minutes). Inter‐rater agreement in the detection of a severe ASE in each individual domain ranged from 0.36 to 0.96. Conclusions The PEDS‐OHCA is the first chart review tool to systematically evaluate the safety and quality of EMS care for children with OHCA. This tool may help improve understanding of the quality of EMS care for children with OHCA, which is essential to improving outcomes.
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Affiliation(s)
- Amanda Schoonover
- Department of Obstetrics & Gynecology Oregon Health & Science University School of Medicine Portland Oregon USA
| | - Carl O. Eriksson
- Department of Pediatrics Oregon Health & Science University School of Medicine Portland Oregon USA
| | - Thuan Nguyen
- Department of Biostatistics Oregon Health & Science University–Portland State University School of Public Health Portland Oregon USA
| | - Garth Meckler
- Department of Pediatrics, School of Medicine University of British Columbia British Columbia Vancouver Canada
| | - Matthew Hansen
- Department of Emergency Medicine Oregon Health & Science University School of Medicine Portland Oregon USA
| | - Tabria Harrod
- Department of Obstetrics & Gynecology Oregon Health & Science University School of Medicine Portland Oregon USA
| | - Jeanne‐Marie Guise
- Department of Obstetrics & Gynecology Oregon Health & Science University School of Medicine Portland Oregon USA
- Department of Pediatrics Oregon Health & Science University School of Medicine Portland Oregon USA
- Department of Emergency Medicine Oregon Health & Science University School of Medicine Portland Oregon USA
- Department of Medical Informatics & Clinical Epidemiology Oregon Health & Science University School of Medicine Portland Oregon USA
- OHSU‐Portland State University School of Public Health Portland Oregon USA
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50
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Abstract
OBJECTIVE To evaluate the characteristics of poisoning-induced out-of-hospital cardiac arrest (pOHCA) and the factors influencing survival to discharge and good neurological outcomes using a nationwide, population-based database. DESIGN Nationwide, retrospective, population-based cohort study. SETTING AND PARTICIPANTS This study included adult patients who had experienced pOHCA and those who had not (non-pOHCA patients) in South Korea from January 2008 to December 2018. OUTCOME MEASURES The primary outcome was survival to discharge, and the secondary outcome was a good neurological outcome. METHODS The basic characteristics of pOHCA and non-pOHCA patients were analysed by descriptive analysis. Logistic regression analysis was conducted for related variables, including pOHCA. RESULTS A total of 173 190 patients were included, and 3582 patients (2.1%) were in the pOHCA group. Some of the pOHCA patients were young (58.2±17.8 vs 69.0±15.5, p<0.001), a few of their cardiac arrests were witnessed (12.8% vs 45.1%, p<0.001), a few were resuscitated by bystanders (8.2% vs 14.8%, p<0.001) and they had low shockable rhythm rates (1.2% vs 8.8%, p<0.001). They showed significantly lower survival to discharge and poorer neurological outcomes than non-pOHCA patients (survival to discharge, 3.7% vs 6.2%, p<0.001; good neurological outcomes, 1.3% vs 3.2%, p<0.001). There were no significant differences between pOHCA and non-pOHCA patients in terms of the adjusted ORs for survival to discharge (adjusted OR 0.608; 95% CI 0.86 to 1.27) and good neurological outcomes (adjusted OR 1.03; 95% CI 0.73 to 1.42). CONCLUSION This study shows that apparent aetiology of OHCA caused by poison, did not influence survival to discharge and good neurological outcomes. Furthermore, pOHCA occurs in younger patients and has fewer witnesses and shockable rhythms. pOHCA did not influence survival to discharge and good neurological outcomes. Also, pesticides and gases were the most frequent substances causing pOHCA in South Korea.
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Affiliation(s)
- Gihun Park
- Department of Emergency Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Chiwon Ahn
- Department of Emergency Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Jae Hwan Kim
- Department of Emergency Medicine, Chung-Ang University, Seoul, Republic of Korea
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